Cardiology Tutorial Flashcards
Why was Miss Elliot referred for a dental review before her cardiac transplant?
Because untreated dental infections pose a significant risk of systemic infection, which can be fatal post-transplant due to immunosuppression.
What are the key cardiac conditions in Miss Elliot’s medical history?
Dilated Cardiomyopathy – weakened heart muscle leading to heart failure.
Severe Left Ventricular Systolic Dysfunction – impaired pumping ability.
How might her epilepsy impact her dental treatment?
Risk of seizures during treatment → Need for seizure precautions.
Tegretol (Carbamazepine) side effects → Gingival overgrowth, xerostomia, and altered drug metabolism.
What is the role of Entresto (Sacubitril/Valsartan) in her treatment, and how does it affect dental care?
Used for heart failure by improving cardiac output.
Can cause hypotension → Risk of dizziness in the dental chair.
How does aspirin influence treatment planning for her dental extraction?
what might be needed
Antiplatelet drug → Increased bleeding risk post-extraction.
Local haemostatic measures like suturing, haemostatic gauze, and tranexamic acid may be needed.
What dental concerns require urgent intervention?
Pain in LL quadrant → Possibly dental caries or pulpal pathology.
Lost crown on 13 → Remaining structure is carious and at the gingival margin, possibly non-restorable.
Caries on 35 (disto-buccal) → May require restoration or RCT.
What haematological abnormalities are present in Miss Elliot’s blood results?
Low Red Cell Count (3.23 x10¹²/L) – Suggests anaemia, likely due to chronic illness or medication effects.
Low Haemoglobin (111 g/L) – Further confirms anaemia.
High Mean Cell Volume (101.9 fl) – Macrocytic anaemia, possibly due to folic acid deficiency (medicated) or bone marrow suppression.
Elevated Glucose (6.4 mmol/L) – Borderline hyperglycaemia; could indicate prediabetes or medication effect.
Why is Mr Gillis required to have a dental review before heart surgery?
He has a history of infective endocarditis → Oral infections pose a serious risk of recurrence, which could be life-threatening post-surgery.
Dental infections are potential sources of bacteraemia, especially before valve surgery.
What is mitral valve regurgitation, and how does it impact dental care?
Incomplete closure of the mitral valve, leading to backflow of blood into the left atrium.
Increases the risk of infective endocarditis, requiring antibiotic prophylaxis before invasive dental procedures.
How does bisoprolol (beta-blocker) affect dental treatment?
Reduces heart rate and blood pressure, but may cause bradycardia and dizziness.
Risk of hypertensive crisis if used with adrenaline-containing local anaesthetics (should use lowest dose possible).
Why is antibiotic prophylaxis important before invasive dental procedures in this patient?
what are the guidelines?
Due to his history of infective endocarditis, guidelines recommend Amoxicillin 3g or Clindamycin 600mg (if allergic) before extractions or periodontal surgery.
What are the most concerning findings in Mr Gillis’ oral examination?
Sinus tract associated with retained roots of 46 & 47 → Indicative of chronic infection that could lead to bacteraemia.
Multiple grossly carious teeth → Poor oral hygiene and potential for further infection.
BPE 4 in multiple sextants → Severe periodontitis, requiring urgent periodontal therapy.
What is the most urgent dental treatment needed for this patient?
Extraction of infected retained roots (46, 47) to eliminate sources of infection.
Periodontal therapy (scaling and root planing) to reduce the bacterial load.
Oral hygiene reinforcement (especially interdental cleaning) to maintain long-term periodontal health.
How should pain management be adjusted for both patients considering their cardiovascular conditions?
Avoid NSAIDs (e.g., ibuprofen, diclofenac) due to increased cardiovascular risk.
Use paracetamol as the first-line analgesic.
If stronger analgesia is needed, consider opioid alternatives (e.g., codeine) with caution due to potential hypotensive effects.
Both patients have cardiovascular conditions. What precautions should be taken for their positioning in the dental chair?
Avoid sudden reclining → Risk of orthostatic hypotension.
Upright or semi-supine position preferred to prevent cardiac decompensation.
