10/12: Cardiovascular Disease Flashcards
Studies have shown that approx. _______% of all patients in academic dental practices suffer from at least 1 chronic systemic disease
50%
What disease is the most prevalent?
Cardiovascular
What is the current survival rate of adult patients who experience cardiac arrest outside the hospital?
Less than 5%
How soon can warning signs and symptoms appear before arrests?
2 weeks
What is a symptom for men in cardiovascular disease?
Chest pain + flu like symptoms
What is a symptom for women in cardiovascular disease?
Shortness of breath + flu like symptoms
More than _____ million americans (about _____% of the population) are estimated to have some form of CD with about _____ million having coronary artery disease
70; 25%; 13
What is the mortality rate (pre covid) of people with CVD?
on the decline, 33%
What is the leading cause of death in the US after age 65?
CVD
What percentage of heart disease risk stems from genetic factors?
30%
Who is more at risk for development of coronary atherosclerotic heart disease at a younger age?
People with parents or siblings affected
Men develop heart disease ____ years earlier on average than women
10, especially with low testosterone, but women catch up post-menopausal
What race is more at risk for heart disease?
African americans
Why are african americans more at risk for heart disease?
Higher risk for hypertension
Majority of people who die of coronary disease are what age?
65 or older
What are risk factors for heart disease?
Smoking
Excessive alcohol use
Stress
Obesity
Diabetes
Cholesterol
Hypertension
Sleep apnea
What is the single most modifiable risk for cardiovascular disease?
Smoking
What are general warning signs and symptoms for heart disease?
Extreme fatigue
Constant dizziness or lightheadedness
Fast heart rate (more than 100bpm)
New, irregular heart beat
Chest pain
Difficulty breathing
Nausea and cold sweats
Edema
What is pitting edema?
Press on a swollen area and an indentation or pit remains
What is edema?
Fluid retention
What are the kinds of fluid retention (or edema)?
Mild
Severe (pitting)
What are the minor risk factors for cardiovascular disease?
Excessive alcohol use
Stress
Age
Narrowing or obstruction is called
Stenosis
What usually experiences stenosis?
Aortic valve
Stenosis can be caused by
Rheumatic fever
Calcification of valve
Vongenita abnormalities
What happens in dyspnea?
Breathing is difficult, labored, uncomfortable
Dyspnea is usually due to
COPD
Asthma
What happens in orthopnea?
Difficulty breathing when lying down
What are the causes of orthopnea?
heart failure, COPD, panic disorder, sleep apnea
This is caused by decreased or blocked blood flow to the heart due to plaque (cholesterol) build up
Coronary heart disease
What is a leading cause of morbidity and mortality in patients with diabetes?
Coronary heart disease
If you have diabetes, you are ______ as likely to have heart disease or stroke than someone who doesn’t have diabetes and at a younger age
twice
The longer you have diabetes, the more likely you are to have…
Heart disease
When you have cardiovascular disease and diabetes, you should manage your
ABCs
What are your ABCs?
A: regular A1c test and aim to stay in you target range
B. Keep blood pressure WNR
C: Manage cholesterol
S: Stop smoking
This is a disease caused by clogging of the arteries
Atherosclerosis
What is a major risk factors for atherosclerosis?
Elevation in serum lipid levels
Increased blood pressure
Is systolic or diastolic levels more strongly related to the incidence of CVD?
Systolic
SBP rises _______, and DBP tends to _______
throughout life; level off or decrease after the age of 50
As atherosclerosis progresses, what can obstructed coronary arteries result in?
Diminished blood supply to the cardiac muscles
What occurs when inadequate perfusion to the myocardium decreases oxygen delivery and clearance of tissue metabolites?
Transient, intermitted chest pain
Is atherosclerosis progressive?
Yes
What 3 things can chest pain cause?
- Angina pectoris
- Hyperventiliation
- Acute M.I
What is the most common thing chest pain causes?
Angina pectoris
What is the least common thing chest pain causes?
Acute M.I, pain is prolonged
What is the most common reason of chest pain?
Hyperventilation
What does angina pectoris result from?
Temporary ischemia of the myocardium
What is the most important symptom of angina?
Chest pain
What is described as a sensation of aching, heavy, squeezing pressure?
Angina
What does angina result as?
Tightness in the midchest region
The area of discomfort is reported to be the size of _____ and may radiate into _____________
Fist; left or right arm, neck or mandible
How long is pain in angina pectoris?
Brief, lasting 5-15 minutes if the provoking stimulus is stopped
What is the cause of angina pectoris?
Blood supply to the cardiac muscle is insufficient for oxygen demand (atherosclerosis or coronary artery spasm)
Angina pectoris can be caused by
Atherosclerosis
You can have hypertension in angina pectoris, but vitals are
Usually normal
What can angina be observe in?
Absence of coronary obstruction-anemia, hypoxemia, or profound hypotension
What can angina episodes be precipitated by?
Stress, anxiety, or physical activity
What kind of angina is pain that is predictable, reproducible, unchanging and consistent over time. Pain is precipitated by physical effort (walking or climbing stairs, but can occur with eating or stress)
Stable angina
What kind of angina may be confused for indigestion?
Stable angina
Can stable or unstable angina pectoris be relieved with the use of nitroglycerin?
Stable angina
Most patients with chronic stable angina have underlying
Coronary artery disease - plaques tend to be slow growing and relatively stable
What angina is defined as new-pnset pain, increasing in frequency, and/or intensity, and is precipitated by less effort than before, can also occur at rest
Unstable angina
What pain is not readily relived by nitroglycerin?
Unstable angina
The key feature of changing character (increasing intensity, frequency) or pattern of pain in what kind of angina pectoris?
Unstable angina
Patients with stable angina have what kind of prognosis?
Relatively good prognosis
Patients with unstable angina have what kind of prognosis?
A poor prognosis and experience an acute MI within a short time
When was nitroglycerine first noted?
1847 - “violent headache”
Factory workers exposed to nitroglycerine coined the term?
“monday disease” when workers first exposed “sunday attacks”
Nitroglycerin exerts action in how many minutes?
2-4 minutes
Nitroglycerins duration of action is how many minutes?
30 min
Side effects of nitroglcyerin?
Pounding in head
Tachycardia
Flushing
Possible Hypotension
What should we do for someone with angina pectoris?
Stress reduction protocol
Avoid excess vasoconstrictors
Oxygen as necessary
Nitroglycerine tabs
- small bottle (plastic or metal, often keychain case)
- 1-2 tabs sublingual
4444 if doesn’t go away
What is treatment for angina pectoris?
Place patient sitting up or semi-sitting position with head elevated
Ensure open airway and breathing is adequate
Check vitals
Dispense/administer nitroglycerin
Always check BP between each dose
How much nitroglycerin should be administered for angina?
Repeat every 5 min up to 3 doses in 15 minute time period. Most only administer 2x
When should you not give an additional dose of nitroglycerin?
If the systolic BP drops below 100mm/Hg because do not want to create profound hypotension and reflex tachycardia
When should you give aspirin to someone with angina pectoris?
AFTER deciding no more nitroglycerin
What medication is recommended for MI?
Aspirin, with 16-325 mg being CHEWED and swallowed to decrease platelet aggregation and limit thrombus formation
What is myocardial infarction manifested as?
Crushing, squeezing or heavy feeling, that is more severe than with angina and lasting longer than 15 minutes; and is not relieved by nitroglycerin in a conscious patient
What are signs of myocardial infarction?
Cyanotic, pale, or ashen appearance; weakness, cold sweat, nausea, vomiting, air hunger and impending death irregular pulse
What is death of cardiac muscle due to?
Inadequate blood oxygen supply
What does death of cardiac muscle progress to?
Cardiac arrest
If a patient is over 8 weeks of treatment for post-myocardial infarction, what happens to dental treatment?
Can have elective treatment
If a patient is less than 8 weeks out of treatment for post-myocardial infarcation, what happens to dental treatment?
No elective dental treatment
What do you need to obtain when >8 weeks out of MI?
Medical consultation:
What is the patients cardiac status?
Is the patient’s cardiac condition stable?
What is the patients ejection fraction?
Does the patient have any degree of heart failure?
Who should you not prescribe NSAIDs to?
A patient who has a history of MI because they increase the risk for subsequent MI
What should a patients INR be on anticoagulants with MI?
2.0-3.0
What are stress reduction protocol?
Short appt
Early morning appt
Nitrous oxide
Limit vasoconstrictors (<2 carpules)
Profound anesthesia
Explain everything “tell, show, do”
What age does congestive heart failure occur?
> 65
What results from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood?
Congestive heart failure
What is not an actual diagnosis?
Congestive heart failure
What is end stage of many CV diseases?
Congestive heart failure
What are the signs and symptoms of CHF?
Fatigue and weakness
Ankle sweating (Edema)
Clubbing of the digits
Syncope (fainting)
Angina
Breathing difficulties
Increase night urination
What is difficult/labored breathing?
Dyspnea
What is sensation of breathlessness in the recumbent position?
Orthopnea
What does sleeping with >2 pillows cause?
Labored caution
