Angina; MI-Stroke-Dr. hasan

Question 1

Angina

Answer 1

• heart muscle is not getting enough blood
  
  • poor coronary circulation
• Ex:
  
  • physical activity
  • strong emotions

Question 2

Types of Angina

Answer 2

• Stable Angina
• Unstable Angina
• Variant Angina
• Microvascular Angina

Question 3

What is another name for Stable Angina

Answer 3

Angina Pectoris

Question 4

When do Stable Angina usually occur?

Answer 4

• occurs when the heart must work harder
  
  • physical exertion

Question 5

Stable Angina Symptoms

Answer 5

• No surprise
• Short (<5 mins)
• might feel like:
  
  • gas or indigestion
  • chest pain that spreads to the arms, back, etc.

Question 6

Stable Angina Tx:

Answer 6

• Rest, nitroglycerin, or both

Question 7

Nitroglycerin

Answer 7

• dilates blood vessels
• may cause headaches

Question 8

What can trigger stable angina:

Answer 8

• Emotional Stress
• Hot or cold temperatures
• Heavy meals
• Smoking

Question 9

What is another name for unstable angina?

Answer 9

• Acute Coronary Syndrome

Question 10

What causes unstable angina

Answer 10

• fatty buildups narrow coronary arteries
• blood clots:
  
  • that partially or totally block an artery
  • dissolve and form again

Question 11

Unstable Angina Symptoms

Answer 11

• occurs at rest, sleeping, little physical exertion
• surprise
• last longer (than stable)
• rest or meds do not relieve
• can get worse overtime
• can lead to a heart attack

Question 12

Unstable Angina Tx:

Answer 12

• Tx as an Emergency-→send to ER
• give pt aspirin to help with pain, clot, and possible irreversible damage

Question 13

What is another name for Variant Angina

Answer 13

• Prinzmetal Angina
• Angina inversa

Question 14

Variant Angina Symptoms

Answer 14

• at rest alway; usually when sleeping
  
  • usually in younger
• relieved by meds

Question 15

What causes variant Angina

Answer 15

• Spasms in coronary arteries due to:
  
  • cold weather
  • stress
  • meds that narrow blood vessels
  • smoking
  • cocaine

Question 16

What causes microvascular angina

Answer 16

• Spasms cut off blood flow in tiny/microvascular blood vessels

Question 17

Microvascular Angina Symptoms

Answer 17

• might be a symptom of coronary microvascular disease (coronary MVD)
• lasts longer than other types
  
  • >10mins; sometimes >30mins
• occurs w:
  
  • Shortness of Breath
  • Sleep Problems
  • Fatigue
  • Lack of Energy
• 1st noticed during routine activities and mental stress

Question 18

Angina: Dental Considerations:

Answer 18

• Ask about frequency & triggers
  
  • Happens at rest?
• Pt must have meds with them
  
  • ask about response to meds & rest
• Avoid elective tx if unstable
• NO can be used if O2>35%

Question 19

Coronary Angiogram

Answer 19

• Special X-ray
• Detects if coronary arteries are Blocked (location, how much) and if you need tx
• Tx not always need. Sometimes Meds and:
  
  • Lower BP
  • Stop Smoking
  • Lower Cholesterol
  • Stay active

Question 20

Angioplasty

Answer 20

• Minor surgery
• opens blocked arteries w/catheter & tiny balloon
• Can start dental work 3-4 days after procedure:
  
  • if pt is on warfarin- INR<3.5

Question 21

What is MI associated with?

Answer 21

• Low cardiac output
  
  • due to muscle damage
  • could lead to CHF
• Cardiac Arrhythmias
• Possibility of another MI
  
  • highest risk within 6 months

Question 22

MI: within 6 months

Answer 22

• High chance of 2nd MI
• avoid GA & elective procedures for 6 months
• No literature-keep low-stress procedures

Question 23

MI: More than 6 months

Answer 23

• consult physician on current status of pt.
  
  • has pt developed CHF post MI?
• Most likely on warfarin: Check INR
  
  • 2-3.5 w/in 24-28 hrs
  • could be on new blood thinner

Question 24

MI: Dental Considerations

Answer 24

• pt might be on warfarin=Get INR
  
  • 2-3.5 w/in 24-48 hours
  • avoid INR<2=meds not working
• Short appointment in morning
• NO is an option

Question 25

Facts about warfarin

Answer 25

• Do NOT stop warfarin
• ONLY stop therapy if pt is on warfarin & aspirin
  
  • stop aspirin 3-5 days before

Question 26

Newer blood thinners

Answer 26

• Fixed doses
• more predictable
• shorter half life (4 hrs)
• no monitoring
• fewer food & drug interactions

Question 27

New Blood Thinners recommendations

Answer 27

• For simple dental tx
  
  • do not interrupt
  • do not take 1-3 hours before

Question 28

Platelet Function tests:

Answer 28

• Closure time assay
• Bleeding time
• Flow Cytometry
• Platelet aggregometry

Question 29

Coronary Artery Bypass Graft (CABG)

Answer 29

• reestablishes blood flow
• Do ASAP after MI to prevent more damage

Question 30

Coronary Artery Bypass Graft: Dental Considerations

Answer 30

• can do any procedures within 6 weeks after procedure
  
  • Avoid Elective procedures for 6 months
• no evidence of infection on graft

Question 31

Heart Transplant: who do you premed?

Answer 31

• Valvulopathy after transplant
• immunocompromised

Question 32

Heart Transplant: Major concerns

Answer 32

• Dry mouth and fungal infection
• Cyclosporin gingival hyperplasia
• avoid elective tx during rejection phase

Question 33

Whats another name for stroke

Answer 33

• cerebrovascular accident (CVA)

Question 34

What are the types of stroke?

Answer 34

• Ischemic Stroke
• Hemorrhagic Stroke
• Cryptogenic stroke
• TIA (transient ischemic attack

Question 35

Ischemic stroke

Answer 35

• clot obstructing flow to the brain

Question 36

hemorrhagic stroke

Answer 36

• rupture blood vessels in brain

Question 37

Cryptogenic stroke

Answer 37

• unknown origin
• consider other conditions:
  
  • A-Fib
  • Patent Foramen Ovale
  • Thrombophillias
  • Large Artery Atherosclerosis

Question 38

TIA

Answer 38

• Transient ischemic attack
  
  • aka mini stroke
  • temporary clot