3.4 Ischaemic Heart Disease

Question 1

What is ischemia?

Answer 1

Insufficient supply of blood tissue due to narrowing of the vascular wall OR reduction of vascular number relative to tissue size

Question 2

What are the risk factors for ischemia?

Answer 2

1. Hyperlipidema
2. Diabetes
3. Obesity
4. Smoking
5. Genetics

Question 3

What are 3 possible consequences of ischemic heart disease?

Answer 3

1. Stable angina
2. Unstable angina
3. Myocardial infartion (heart attack +/- sudden death)

Question 4

What are the signs + symptoms of stable angina?

Answer 4

1. Coronary artery narrowing
2. > 70% blockage
3. O2 demad greater than supply
4. Chest pain ON EXERTION (<15 mins + releif with rest)
5. ECG = ST depression when experiencing chest pain

Question 5

What are the signs + symptoms of unstable angina?

Answer 5

1. More severe coronary artery narrowing
2. > 90% blockage + unstable plaque
3. Significantly decreased O2 supply
4. Chest pain ANYTIME (<15 mins + may not relieve with rest)
5. ECG = ST depression when experiencing chest pain

Question 6

What are the signs + symptoms of myocardial infarction?

Answer 6

1. Total blockage of coronary artery (100%)
2. O2 supply stopped
3. Crushing chest pain + radiation left arm and jaw
4. Not responsive no nitrate
5. ECG = ST elevation + arrhythmia
6. Troponin + creatine kinase elevation
7. Ventricular fibrillation

Question 7

How can ischemic heart disease be diagnosed before infarction?

Answer 7

1. Patient history (chest pain, smoking etc)
2. Physical examination (BMI etc)
3. Lab tests (LDL, HDL, triglyceride levels + blood sugar level)
4. ECG
5. Angiography

Question 8

In basic emergency management for angina or MI during a dental appointment, what steps should be taken before treatment?

Answer 8

1. Take patient history
2. Ask patient if they have their medications on hand (if previous chest pain history)

Question 9

In basic emergency management for angina or MI during a dental appointment, what steps should be taken at initial flare up?

Answer 9

1. Stop and reassure patient
2. Give glyceryl trinitrate (tablet or spray form, remember spray form has short half-life)
3. Monitor + call 000 if not relieved after 10 mins

Question 10

In basic emergency management for angina or MI during a dental appointment, what steps should be taken before a called ambulance arrives?

Answer 10

1. Give oxygen + aspirin (300mg)
2. Give pain killer as required (morphine)
3. Defibrillate as required
4. If syncope, CPR

Question 11

In basic emergency management for angina or MI during a dental appointment, what steps should be taken after patient’s arrival at hospital?

Answer 11

1. Angioplasty - stents
2. Bypass

Question 12

When is it safe to treat patients with MI?

Answer 12

< 3 months = high risk of reinfarcation

Delay elevtive treatment to > 6 months

Consult medical practitioners for patient heart function

Medication present at next appointment + monitor closely

Question 13

How can ischaemic heart disease be managed?

Answer 13

Lifestyle changes (exercise, quit smoking)

Control of hyperlipidemia via lipid control drugs (statins) = single most effective way of reducing cardiac disease

Control high blood pressure (beta blockers, calcium channel blockers, ACE inhibitors)

Control diabetes

Angioplasty

Question 14

What is the role of dental professionals in heart disease management?

Answer 14

Periodontitis + heart disease have shared common risk factors

Preventing periodontitis can help prevent heart disease

Dental professional can help diagnose atherosclerosis via OPG