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Cardio Final Flashcards

1
Q

A Congenital Heart Deft is…

A

An abnormality of the heart or great vessels which are present from birth

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2
Q

The two types of congenital heart defects are

A

cyanotic and acyanotic

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3
Q

A nickname for cyanosis is…

A

blue babies (eaLRy cyanosis)

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4
Q

Cyanosis is…

A

is a right-to-left shunt in which de-oxygenated blood is shunted into systemic circulation.

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5
Q

Does cyanosis require treatment?

A

yes, urgent surgical treatment or maintenance of a PDA

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6
Q

What are the 5 T’s of Cyanotic congenital heart disease?

A

Truncus arteriosus
transposition
tricuspid atresia
tetralogy of fallot
TAPVR

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7
Q

What is the nickname for acyanosis?

A

pink babies (LateR cyanosis)

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8
Q

Acyanosis results in

A

left to right shunts of oxygenated blood from the lungs back into the pulmonary circulation.

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9
Q

which is more severe - cyanosis or acyanosis?

A

cyanosis

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10
Q

is premedication needed for acyanosis?

A

no

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11
Q

what are the results of acyanotic defects

A

Volume overload or pressure overload

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12
Q

in regard to acyanotic defects, what are the types of volume overload?

A

ASD, VSD, PDA

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13
Q

in regard to acyanotic defects, what are the types of pressure overload?

A

AS, pulmonic stenosis, coarctation of the aorta

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14
Q

What causes chronic volume overload

A

left to right shunt, increases pulmonary vascular resistance, reversal direction of shunt flow, subsequent cyanosis

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15
Q

What is infective endocarditis?

A

a rare disorder that causes inflammation of the endocardium

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16
Q

What causes inflammation of the endocardium

A

exposure to bacteria through trauma
infection of the valves
arrythmias

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17
Q

FROM JANE pneumonic

A

Fever
Roth Spots
Osler Nodes
Murmur
Janeway Lesions
Anemia
Nail bed hemorrhage
Emboli

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18
Q

When is antibiotic prophylaxis indicated for infective endocarditis

A

-history of infective endocarditis
-prosthetic heart valve
-heart transplant with vavlular regurgitation
-unrepaired cyanotic heart disease
-repaired congenital heart defects with residual shunts or valvular regurgitation

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19
Q

What are some dental procedures the warrant antibiotic prophylaxis?

A

Manipulation of the gingiva
working in the periapical region
extractions
cleanings and SRPs
Fitting orthodontic bands
Placement of temporary anchoring devices
Biopsy
Sutures

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20
Q

What immunocompromised patients warrant antibiotic prophylaxis?

A

-patients with HIV whose T cell count is <200
-recipients of a bone marrow transplant
-patients suffering from neutropenia
-patients with a history of chemo
-patients with rheumatoid arthritis
-uncontrolled diabetics

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21
Q

Antibiotic prophylaxis guidelines

A

oral: amoxicillin 2g or 50mg/kg or azithromycin (500mg)
IM or IV: ampicillin or cefazolin(1g)

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22
Q

What is rheumatic fever?

A

Rheumatic fever is an autoimmune inflammatory process that develops two or four weeks after a strep throat infection

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23
Q

what are the major manifestations of rheumatic fever?

A

J(heart)NES
-Joint = migratory polyarthritis of the large joints
-Heart carditis of all three layers
-Nodules in the skin
-Erythema marginatum
-Syndenham chorea - a neurologic disorder with involuntary rapid movements

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24
Q

What is the diagnostic requirements for rheumatic fever?

A

evidence of streptococcus infection
two major criteria
one major + two minor criteria

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25
What is the most common type of hypertension?
primary or essential
26
secondary hypertension is caused by what?
secondary hypertension is caused by another medical condition or medication
27
acute hypertension
acute hypertension is caused by physical exertion, anxiety or stress caused by physical exertion, anxiety, or stress BP IS NORMAL ONCE STIMULUS IS REMOVED
28
Chronic Hypertension
high blood pressure that occurs with or without stimuli
29
White-coat stimuli hypertension
hypertension experienced in a healthcare setting and is common in older populations
30
what is the AHA categories of Blood Pressure?
Normal Elevated High - stage 1 High -stage 2 Hypertensive Crisis
31
Normal BP
Systolic: less than 120 AND Diastolic: less than 80
32
Elevated BP
Systolic: 120-129 AND Diastolic: less than 80
33
High - Stage 1 BP
Systolic: 130-139 OR Diastolic: 80-89
34
High - Stage 2 BP
Systolic: 140+ OR Diastolic: 90+
35
Hypertensive Crisis BP
Systolic: 180+ AND/OR Diastolic: 120+
36
What are the risk of hypertension?
Obesity Smoking High sodium/alcohol diet old age family history medications & disease (2ndary)
37
What are some medications used to treat HTN?
alpha blockers alpha 2 agonists vasodilators peripheral adrenergic inhibitors beta blockers alpha and beta blockers CCBs Diuretics ACE inhibitors Angiotensin II Receptor Blockers
38
What are some oral side effects of HTN meds?
xerostomia gingival hyperplasia Angioedema and dry cough bleeding gums
39
What are some management techniques for patients with hypertension? BP <160/100
Elective: none Emergency: none
40
What are some management techniques for patients with hypertension? BP >160/100
Elective: if repeated, get clearance Emergency: use stress management every 10-15 min
41
What are some management techniques for patients with hypertension? BP Systolic >180 snd/or diastolic >100
DEFER AND REFER TO PHYSICIAN
42
What is the classification of lipoprotein particles?
HDL LDL IDL VLDL chylomicrons
43
What is the cascade for hyperlipidemia and atherosclerosis?
1. high levels of lipids in the blood 2. build-up of fat deposits in the arterial walls 3. displace endothelial cells from smooth muscle ***blocks nitric oxides vasodilatory effects 4. increased risk for cardiac events
44
What are the classifications of angina?
stable = chest pain at exertion unstable = chest pain at rest
45
what is ischemia?
the heart does not get enough oxygen but not enough to result in necrosis
46
What is the protocol for angina?
oxygen THEN nitroglycerin THEN aspirin
47
MI - myocardial infarction
is a heart attack ischemia and necrosis
48
What is the most commonly occluded vessel in MI
Left anterior descending artery (LAD)
49
Can you provide emergency dental care within 6 months after an MI?
Yes
50
When can elective dental care be resumed after MI?
after 6 months
51
What is Turner Syndrome?
45 XO aneuploidy it is a genetic disorder that affects the development of females it is a missing x chromosome and is usually evident by age 5
52
What are the dental signs of Tuner syndrome?
high arched palate dental
53
Trisomy 21
down syndrome 3 copies of chromosome 21
54
Marfan's syndrome
aortic root aneurysm/dissection ectopic lentils low levels of fibrillin FBN1 gene on chromosome 15 long arms, legs, fingers, and toes
55
DiGeorge Syndrom
Micro deletion of chromosome 22q11.2 cleft palate hypocalcemia thymic hypoplasia 80% with CHD
56
Familial hypercholesterolemia
most common of the mendelian disorders LDL has impaired transport and catabolism in the liver and develops skin xanthomas and premature atherosclerosis
57
What are CMPs?
cardiomyopathies are diverse heart muscle disorder that affects myocardial systolic and/or diastolic function
58
what are the types of CMPs?
Dialated CM Hypertrophic CM Restrictive CM Arrhythmogenic CM Unclassified
59
What is dilated cardiomyopathy (DCM)
DCM is a progressive disease of the heart muscle that is characterized by ventricular chamber enlargement and systolic dysfunction. *** the right ventricle may be also dilated and dysfunctional
60
what is the morphology of DCM?
large heart with all 4 chambers dialated
61
what are the causes of DCM?
Genetic Myocarditis Toxins Pregnancy CV diseases Idiopathic
62
What is hypertrophic Cardiomyopathy (HCM)
A heritable autosomal dominant disease of the heart characterized by marker hypertrophy of the myocardium with myofibril dissarray and and small LV cavity
63
How to diagnose HCM?
History and physical exam ECG (likely abnormal) Chest x-ray (cardiomegaly) ECHO Genetic Testing Cardiac Muscle Biopsy (myofibril disarray)
64
Restrictive Cardiomyopathy (RCM)
RCM is impaired ventricular filling with normal or decreased diastolic volume of either or both ventricles
65
What is a characteristics of RCM?
The ejection fraction is greater than 50%
66
What are some symptoms associated with RCM?
edema Elevated JVP Hepatic congestion Dyspnea
67
The leading cause of death in the US is heart disease. What is the greatest risk for cardiovascular disease?
obesity
68
What is obesity
an imbalance between food consumed and physical activity that results in the accumulation of fat in adipose tissue and causes adverse effects on health
69
What are some non-modifiable risk factors that affect obesity?
age and genetics
70
What are the 3 ways to measure body fat?
BMI (weight/height) Waist circumfrence Waist to hip ration
71
What happens to adipocytes in obese individuals?
hypertrophy(size) and/or hyperplasia(number)
72
What is the criteria for dyslipidemia and atherosclerosis?
High >200 High LDL> 130 Low<40 High triglycerideride >150
73
What is a normal blood glucose level?
fasting (80-100) after eating(170-200) 2-3 after eating (120-140)
74
What is an impaired blood glucose level?
fasting (101-125) after eating(190-230) 2-3 after eating (140)
75
What is a diabetic blood glucose level?
fasting (126+) after eating(220-300)
76
What is metabolic syndrome?
central obesity high blood pressure insulin resistence high triglycerides low HDL cholesterol
77
What are some ways for nutritional management?
weight reduction lifestyle modification change of diet (dash) salt restrictions no alcohol
78
What is the difference between the Mediterranean and Western diets?
Mediterranean is nutrient dense Westen is energy dense
79
What is the difference between a prebiotic and a probiotic?
Probiotic = alive bacteria (yogurt) Prebiotic = probiotic's nutrients and is nondigestable
80
What is heart failure?
heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through the heart to meet the body's needs for blood and oxygen HALLMARK = LOW CARDIAC OUTPUT
81
What are the risk factors for developing heart failure?
coronary artery disease advanced age hypertension diabetes obesity smoking valvular heart disease race (black)
82
What are the categories of heart failure?
systolic diastolic right-sided
83
What is systolic heart failure?
characterized by an insufficient ejection fraction of the left ventricle with subsequent poor perfusion of end organs PUMPING PROBLEM, DECREASED EJECTION FRACTION
84
What is diastolic failure?
Diastolic failure is characterized by a decreased expansion and filling of the left ventricles with blood during diastole FILLING PROBLEM, NORMAL EJECTION FRACTION
85
What is right-sided heart failure?
characterized by tissue congestion with jugular distension (JVD), periperal edema, acites, and organ engorgenment
86
What is pulmonary hypertension?
Pulmonary hypertension (PH) is an increase in mean pulmonary artery greater or equal to 25mm Hg at rest or greater than 30 mm Hg during exercise.
87
What is the mechanism of pulmonary hypertension?
The mechanism of pulmonary hypertension is due to increased pulmonary vascular resistance that eventually leads to right ventricular failure
88
What is the normal mean pulmonary artery
20mm Hg
89
How many classes of PH are there based on the WHO?
5
90
Group 1 PH
Pulmonary arterial hypertension (PAH)
91
Group 2 PAH
Pulmonary hypertension (PH) secondary to left heart disease -heart failure, valvular heart disease
92
Group 3 PAH
PH from chronic lung disease and/or hypoxia-obstructive lung disease, restrictive lung disease
93
Group 4 PAH
PH due to pulmonary artery obstructions-chronic thromboembolic PH
94
Group 5 PH
PH due to unclear and/or multifactorial mechanisms-systemic and metabolic disorders.
95
How many stages of PH are there according the the WHO?
4
96
Class I PH
No limitation with functional activity
97
Class II PH
Comfortable at rest but has slight limitations with activity such as shopping, climbing stairs, or making the bed
98
Class III PH
Comfortable at rest but has significant limitations with activity such as activities of daily living such as dressing, bathing, toileting, or transfers.
99
Class IV PH
Symptoms at rest. Signs and symptoms suggestive of right-sided congestive heart failure.
100
What are the types of shock?
Hypovolemic cardiogenic obstructive distributive
101
hypovolemic shock
↓blood volume resulting from internal or external fluid loss
102
cardiogenic shock
Acute MI End-stage cardiomyopathy Advanced valvular disease Cardiac arrhythmias
103
Obstructive shock
Pulmonary embolism Cardiac tamponade Tension pneumothorax increase in intrathoracic pressure
104
Distributive shock
Inflammatory mediators disrupt blood flow: Severe sepsis Anaphylaxis Neurogenic shock
105
What are characteristics of diastolic heart failure?
-Small LV cavity, concentric LV hypertrophy. -Systemic hypertension is a common cause. -Elderly women are more common -Normal or increased EF -S4 gallop (atrial gallop); late diastolic sound from forceful atrial contraction into a stiff ventricle -Prognosis not as poor. -Myocardial ischemia is common.
106
What are characteristics of systolic heart failure?
*Large dilated heart. *Normal or low BP *Broad age group, more men. *Low ejection fraction (EF). *S3 gallop: ventricular gallop possibly caused by tensing of chordae tendinaeduring rapid filling and expansion of the ventricle *Poor prognosis *Some cases with a myocardial ischemia role.
107
What are the types of heart failiure?
Left, right, and backwards
108
What is left heart failure?
*Dyspnea, especially on exertion *Paroxysmal nocturnal dyspnea (sudden wake-up short of breath) *Orthopnea (cannot breathe lying flat)
109
What is Right heart failure?
*Increased jugular venous pressure *Lower extremities edema *Liver congestion (rarely can cause cirrhosis)
110
What are causes of acute heart failure?
*Large acute MI. *Acute valvular dysfunction (mitral or aortic regurgitation). *Fluid overload. *Acute right heart failure may occur with pulmonary emboli
111
What are the causes of chronic heart failure?
*Chronic Ischemic Heart Disease *Chronic work overload --Hypertension --Valve diseases *Dilated cardiomyopathies *Shunting in ASDs, VSDs, PDAs
112
How do you manage acute HF?
DIURESE , DIURESE, DIURESE
113
How do you manage chronic HF?
Improve Symptoms, Improve LVEF,Improve Mortality, Prevent Hospitalizations
114
Angiotensin converting enzyme inhibitors (ACEI)
Captopril Lisinopril Enalapril
115
Angiotensin receptor blockers (ARB)
Losartan Valsartan Candesartan
116
Beta Blockers
Metoprolol XL Carvedilol Bisoprolol
117
Aldosterone Antagonist
Spironolactone
118
Diuretics
Furosemide (Loop) Torsemide (Loop) Bumetanide (Loop) Hydrochlorothiazide (Thiazide)
119
Inotropic Agents
Digoxin Dobutamine
120
Direct Vasodilators and Venodilators
Hydralazine Nitroglycerin
121
Neprilysin Inhibitor
Sacubitril
122
Anti-Arrhythmic Drugs
Amiodarone

Cardiovascular (5 decks)

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