4. CVD heart failure, valvular heart ds, infectious endocarditis

Question 1

which ventricle typically fails first in hearth failure

Answer 1

the left ventricle

Question 2

how to calculate the EF

Answer 2

EF = ejection fraction

Question 3

normal, borderline and reduced EF

Answer 3

normal is 50 to 70%

borderline is 41 to 49%

reduced is less than 40%

Question 4

signs of heart failure

Answer 4

• rapid, shallow breathing
• inspiratory rales (crackles)
• incr. heart rate
• distended jugular (neck) veins
• peripheral edema
• ascites
• cyanosis
• weight gain
• clubbing of fingers
  *

Question 5

whats this

Answer 5

distended jugular neck vein

a sign of heart failure

Question 6

whats this

Answer 6

clubbing of fingers

a sign of heart failure

Question 7

symptoms of heart failure

Answer 7

• fatigue and weakness
• orthopnea (dyspnea in recumbent position)
• exercise intolerance
• muscular fatigue
• feeling heavy (weight gain)
• GI distress (nausea, vomitting and constipation)

Question 8

stage A

Answer 8

at high risk for HF but WITHOU structural heart ds or symptoms of HF

Question 9

stage B

Answer 9

structural heart ds but WITHOUT signs or symptoms of HF

Question 10

stage C

Answer 10

structural heart disease with prior or current symptoms of HF

Question 11

stage D

Answer 11

refractory HF requiring specialized interventions

Question 12

does data support or refute efficacy of dental tx (clearance) prior to cardiac surgery

Answer 12

it cannot support or refute

Question 13

what is the main question to ask when dealing with any pts with heart failure

Answer 13

does the benefit of providing dental tx outweigh the RISK of potential complications

looking into if the heart can or cannot manage the stress of a dental procedure

Question 14

what kind of detnal care can we do for the following classes of HF

class I

class II

class III

class IV

Answer 14

class I: routine dental care ok

class II: medical consultation required, routine dental care likely ok

class III and IV: consider referral to specialized care

Question 15

what is valvular stenosis

Answer 15

that they do not open properly

Question 16

what is valvular insufficiency

Answer 16

that they do not close properly and associated with regurgitation

Question 17

valvular ds - fibrosis what is it

Answer 17

stiff, sclerosis, stenosis cuasing either stenosis or insufficency

Question 18

valvular heart disease- myxomatous degeneration

Answer 18

• benign loose CT tumorous changes where valves become floppy, prolapse, regurgitation
• causess insufficiency

Question 19

signs of valvular heart disease

Answer 19

murmurs

syncope

HF

shortness of breath

Question 20

symptoms of vavular heart disease

Answer 20

• heart failure
• exercise intolerance
• shortness of breath (can also be a symptom)

Question 21

medical management of valvular heart ds

Answer 21

tx is primarily surgical, valve replacement (mechanical and bioprosthetic implants), predisposition for infective endocarditis

Question 22

dental considerations for valvular heart ds

Answer 22

• assess ability to tolerate care in context of underlying condition and comorbidites
• asses bleeding risk- INR, local hemostatic measures in place
• infections - determine need for ab prophylaxis and ab of choice
• drug effects - review med list

Question 23

what is infective endocarditis

Answer 23

• infection of inner layer of heart usually affects cardiac valves
• was almost always fatal until development of penicillin
• 15,000 cases diagnosed in US each year
• done through blood turbulence within heart allows causative agent to infect previously damaged vales or other endothelial surfaces.

Question 24

AHA cardiovascular indications for ab prophylaxis:

Answer 24

• prosthetic cardiac valves
• prosthetic material used
• cardiac transplantation with valve regurgitation due to abnormal valve
• prev endocarditits
• CHD
  
  • completely repaire with prosthetic material or device
  • reapired CHD with residual shunts or valvular regurgitation
  • urepaired cyanotic CHD

Question 25

on a prescription, what do you write

Answer 25

drug

how many

and how to take it

Question 26

what does not require ab prophylaxis:

Answer 26

hear murmur, mitral valbe prolapse, mitral valve prolapse with regurgitation, rheumatic fever, stent or coronary artery bypass graft, tooth shedding or trauma

*if any murmur due to endocarditis, prosthetic heart valve, complex congenitary cyanotic heart ds, AHA continues to recommend ab prophylacis for most dental procedures.

Question 27

why are some procedure not requried for antibiotic prophylaxis

Answer 27

because:

1. unlikely to manipulate the gingival tissue
2. unlikely to manipulate the periapex of teeth
3. unlikely to perforate the oral mucosa

(hear murmur, mitral valbe prolapse, mitral valve prolapse with regurgitation, rheumatic fever, stent or coronary artery bypass graft, tooth shedding or trauma)