4. Medical Emergencies: Cardiovascular Flashcards
Atherosclerosis “ a chronic ____
response in the walls of arteries caused by the formation of multiple ____ ”
inflammatory
plaques
Clinical Manifestations of Atherosclerosis
NONCARDIAC
Diabetes mellitus
-diabetic ____ and
blindness
-increased ____ rate -poor healing of ____ limbs
Cerebral arteries
- ____ attack
- cerebrovascular ____
retinopathy
infection
lower
transient ischemic
infarction
Clinical Manifestations of Atherosclerosis
CARDIAC
Coronary artery disease
- ____ pectoris
- ____ angina
- ____ infarction
- ____ failure
- ____
- ____ death (cardiopulmonary arrest)
angina
unstable
myocardial
congestive heart
dysthrythmias
sudden
Coronary Artery Disease “ the end result of the
accumulation of plaques ____ the walls of the arteries that supply the myocardium with oxygen and nutrients ”
within
Again, coronary artery disease can manifest as ____ pectoris, or chest pain as we know it. This can be of a ____ variety which occurs only with exertion. So some kind of stressful event like after walking a couple blocks. This can be ____ when it happens at rest. Or if its happening at an increasing frequency – if the patient is having daily episodes of chest pain this would be unstable angina.
There’s also a variant called ____ disease and that’s also a form of angina, which will not be plaque formation in the coronary vessels but will result from ____ of the coronary vessels. So the lumen of those vessels will be diminished. We need those vessels to supply oxygen and nutrients to the heart so patients will manifest with the same kind of symptoms – chest pain – when they have this issue as well. And coronary artery disease can obviously lead to ____ and cardiopulmonary ____.
angina
stable
unstable
prinzmetal
spasm
MI
arrest
Coronary Artery Disease: Incidence and Prevalence
● Affects approximately 14 million people
in the United States
● ____ cause of death
● Approximately 500,000-700,000 deaths
are caused by coronary artery disease annually in the United States
leading
If you look at the various age groups – you look at these younger age groups (the 5-14, 15-24, 25-44 age groups) the most common cause of deaths in these patients are ____ deaths as well as ____ being the second most common in the younger age groups (5-14, 15-24).
We do start to see ____ disease creep up in the 25-44 age groups (as the second most common cause of death), more so in the patients over ____ or late 30’s that we see heart disease surpass cancer as the ____ most common cause of death.
accidental
cancer
heart
40
second
Then we will see in the 45-64 year old group and the older elderly individuals, the 85+, that ____ disease predominates as the ____ killer in these two groups, followed by cancer, and then you see ____ accidents or strokes. So these problems are prevalent. Atherosclerosis manifesting in the brain in the form of CVA and in the heart in the form of coronary heart disease.
heart
leading
cerebrovascular
Coronary Artery Disease: Risk Factors
Uncontrollable:
● ____
● ____
● ____ history
Controllable: ● Hypertension ● Smoking ● Hypercholesterolemia ● Diabetes ● Obesity ● Stress ● Type A personality ● Sedentary lifestyle
male
age
family
Sex
● ____ have a greater incidence of
CAD than females
● Women follow men by ____ years
males
10
Age
● Increasing ____ = increasing CAD
● ____ risk factor
● ____ persons experience higher mortality and morbidity rates from CAD
age
strongest
elderly
Hypertension
“ a consistent state of elevated blood pressure above ____ mm Hg ”
140/90
Classification of Blood Pressure
HTN: Stage 3 Systolic (mmHg): \_\_\_\_ HTN: Stage 2 Systolic (mmHg): \_\_\_\_ HTN: Stage 1 Systolic (mmHg): \_\_\_\_
Borderline HTN: Systolic (mmHg): ____
Normal: Systolic (mmHg): ____
> 180
160-179
=140-159
135-139
<135
Classification of Blood Pressure
HTN: Stage 3 Diastolic (mmHg): \_\_\_\_ HTN: Stage 2 Diastolic (mmHg): \_\_\_\_ HTN: Stage 1 Diastolic (mmHg): \_\_\_\_
Borderline HTN: Systolic (mmHg): ____
Normal: Systolic (mmHg): ____
> 110
100-109
90-99
85-89
85
Hypertension: Etiology
● Essential (idiopathic) - accounts for
____%; obesity, salt sensitivity, renin homeostasis, insulin resistance, genetics, and age may be contributing factors
● Secondary - result of identifiable process
such as ____, primary aldosteronism, ____ syndrome, oral contraceptives, or renal disease
90-95
pheochromocytoma
cushing’s
Hypertension: Incidence
● ____% of U.S. population has hypertension
20
Hypertension: Clinical Presentation
1st stage:
no ____
2nd stage: \_\_\_\_ (occipital) \_\_\_\_ \_\_\_\_ \_\_\_\_ \_\_\_\_ changes – arteriolar narrowing \_\_\_\_ changes
3rd stage: \_\_\_\_, MI Accelerated \_\_\_\_ CHF, \_\_\_\_ Blindness Proteinuria, \_\_\_\_ CVA
symptoms
headaches vertigo flushing epistaxis retinal EKG
angina
atherosclerosis
LVH
ESRD
Modified Stepped- Care Approach to Hypertension
Step 1. Begin with medically-supervised ____ changes and observation
Step 2. Begin pharmacologic therapy with one of the following: - a \_\_\_\_ - an \_\_\_\_ blocker - an \_\_\_\_ inhibitor - an \_\_\_\_ antagonist - a \_\_\_\_ channel blocker
Step 3. Continue ____ drugs of different pharmacologic class found in step 2.
lifestyle
diuretic a or b ACE angiotensin II receptor calcium
two
Dental Management of the Hypertensive Patient: Reduction of Stress and Anxiety
● Establish honest, supportive relationship with
patient
● Discuss patient’s questions, concerns, fears
● Schedule ____ appointments
● Avoid ____ appointments
● Use pre-medication as needed - ____
● Use ____ as needed (avoid hypoxia)
● Provide gradual changes of position to avoid ____
● Avoid stimulating ____ reflex
● ____ patient if he or she appears to be overstressed
morning long diazepam nitrous oxide postural hypotension gag dismiss
Smoking
● In males, 5 fold greater risk of ____ and a 3 fold greater risk of fatal ____ when compared to non-smokers
CVA
MI
Cholesterol
● Typical daily internal production is about ____ g and dietary intake is ____ mg
● Primarily synthesized from ____ through the HMG-CoA reductase pathway
● ____ in blood
● Transported in the circulatory system within lipoproteins
● Higher concentrations of ____ and lower concentrations of ____ are strongly associated with cardiovascular disease because these promote atherosclerosis
1 200-300 acetyl CoA insoluble LDL HDL
Cholesterol: Guidelines
● < ____ mg/dl = normal
● ____ mg/dl = borderline
● > ____ mg/dl = high risk; ____ X increase in
heart disease
● > ____ mg/dl = ____ X increase in heart disease
200 200-239 240 2 300 4
Cholesterol: Guidelines
Total Cholesterol < ____ mg/dl
HDL >____ mg/dl
LDL
200
70
100
Lipid-Lowering Drugs
Bile Acid Sequestrants
____
Colestipol
HMG CoA Reductase Inhibitors Atorva\_\_\_\_ Fluvastatin Lovastatin Simvastatin Pravastatin
Fibric Acid Derivatives
____
Miscellaneous drugs and natural compounds \_\_\_\_ \_\_\_\_ \_\_\_\_ (vitamin B3, niacin) \_\_\_\_
cholestyramine statin gemfibrozil estrogens probucol nicotinic acid vitamin E
Diabetes
● ____ X risk for CAD when ____ is present
2
diabetes mellitus
Obesity Increased risk of: \_\_\_\_ disease Hypertension \_\_\_\_ Type II diabetes mellitus \_\_\_\_ Obstructive sleep apnea
coronary artery
hypercholesterolemia
osteoarthritis
Alcohol
● “Moderate” consumption
increases serum levels of
____
HDL
Laboratory Tests for Coronary Heart Disease ● \_\_\_\_ blood tests ● \_\_\_\_ lipid profile ● Twelve-lead \_\_\_\_ ● \_\_\_\_ ECG stress test ● \_\_\_\_ ● \_\_\_\_ imaging studies using thallium, sestamibi, or teboroxime ● \_\_\_\_, adenosine or dobutamine nuclear stress test ● \_\_\_\_ angiography ● Increased \_\_\_\_ markers
routine fasting ECG treadmill echocardiography nuclear persantine MR serum
Management of CAD
● ____% reduction in mortality from CAD over the past 3 decades
● Prevention
◆ Control ____ factors
◆ ____ modification
◆ ____
● Treatment
◆ Medical
◆ Surgical
30
risk
lifestyle
aspirin
CAD: Treatment
● Medical therapy:
◆ Drugs
◆ Alter risk factors
◆ ____ (PTCA)
percutaneous transluminal coronary angioplasty
