cardiovascular Flashcards
Angiotensin converting enzyme (Ace) inhibitors
- method of action
- uses
- side effects
- contraindications
- examples
Method of Action: Inhibit the enzyme to prevent production of Angiotensin 2 in the lungs, limiting the release of Aldosterone from the adrenal glands
Uses: Hypertension (first line) and all associated cardiovascular conditions
Side effect: Dry cough, candida, fatigue, hyperkalemia
Contraindications: Hypersensitivity, impaired kidney disease
- Caution when prescribing with NSAIDs, ARBs, anticoagulants and cyclosporine
Example: Lisinopril, Ramipril (Ends with –Pril)
Angiotensin 2 Receptor blocker (arbs)
- method of action
- uses
- side effects
- contraindications
- examples
Method of Action: Blocks the angiotensin 2 receptors that would otherwise cause vasoconstriction and release of aldosterone
Uses: Hypertension (first line) and all associated cardiovascular diseases
Side effect: Dry mouth, hyperkalemia
Contraindications: Don’t prescribe to people taking oral NSAIDs, people with bilateral renal artery stenosis,
Example: Losartan, valsartan (ends in –Sartan)
thyronamines
- •Method of Action:
- •Uses:
- •Side effect:
- •Contraindications:
- •Example:
- Method of Action: Interfere with iodine oxidation so reduce T3/4 production
- Uses: Hyperthyroidism
- Side effect: Rash, joint pain, dizziness, feeling unwell
- Contraindications: Hepatic disorders
- Example: Carbimazole
calcium channel blockers
- Method of Action:
- Uses:
- Side effect:
- Contraindications:
- Example:
- Method of Action: Block calcium channels so smooth muscle constriction is reduced and vasoconstriction is reduced lowering blood pressure
- Uses: Hypertension, arrhythmias (class 1 antiarrhythmic), disorders of the smooth muscle such as achalasia
- Side effect: Gingival hypertrophy (nifedipine)
- Contraindications: Hypersensitivity, hypotension
- Example: Nifedipine, amlodipine (Ends in –Ipine)
potassium sparing diuretics
- Method of Action:
- Uses:
- Side effect:
- Contraindications:
- Example:
- Method of Action: Block aldosterone and sodium channels
- Uses: Hypertension or conns disease
- Side effect: Hyperkalaemia, low sodium, dry mouth, hyperglycaemia
- Contraindications: Patients who are taking potassium supplements, people who suffer from conns disease
- Example: Spironolactone
thiazide like diuretics
Method of Action:
Uses:
Side effect:
Contraindications:
Example:
- Method of Action: Act on the kidney to increase sodium excretion leading to increased water loss, also dilates smooth muscles
- Uses: Hypertension, treatment of oedema (such as from alcoholism or heart failure)
- Side effect: Hypokalaemia
- Contraindications: hypotension, hypersensitivity, renal failure
- Example: Chlorothiazide
nitrates
Method of Action:
Uses:
Side effect:
Contraindications:
Example:
- Method of Action: increase vasodilation to the coronary artery so the heart gets enough blood
- Uses: Angina
- Side effect: Hypotension, burning or tingling in mouth, headache, nausea
- Contraindications: Hypotension, bradycardia, right ventricle infarction
- Example: Trinitroglycerin (GTN) spray
beta blockers
Method of Action:
Uses:
Side effect:
Contraindications:
Example:
- Method of Action: Bind to beta adrenergic receptors to prevent their action, reducing the rate and strength of heart contractions
- Uses: Hypertension, arrhythmia (class 2 antiarrhythmic), palpitations in anxiety
- Side effect: Beta adrenergic surge leading to rebound tachycardia if therapy is suddenly stopped, dry mouth, dry skin, fatigue, dizziness
- Contraindications: Symptomatic bradycardia, asthma, atrioventricular block
- Example: Atenolol (Ends in –Olol)
inotropic drugs
Method of Action:
Uses:
Side effect:
Contraindications:
Example:
- Method of Action: Alter the contractile force of the heart, increasing its efficiency
- Uses: Heart failure
- Side effect: Arrhythmia, raised myocardial oxygen demand
- Contraindications: Hypertrophic obstructive cardiomyopathy
- Example: Dobutamine (Ends in –Amine)
statins
Method of Action:
Uses:
Side effect
Contraindication
Example:
- Method of Action: Reduce cholesterol by inhibiting action of HMG-CoA reductase
- Uses: Ischaemic heart disease, general reduction of cholesterol
- Side effect: Abdominal pain, diarrhoea, rash
- Contraindications: Pregnancy, breastfeeding, active hepatic diease, people taking amlodipine
- Example: Simvastatin (End in –Statin)
oxygen
Method of Action:
Uses:
Side effect
Contraindication
- Method of Action: Relieved tissue hypoxia
- Uses: Any respiratory or cardiovascular emergency
- 15L/min of 100% oxygen is typical dose
- Side effect: Drowsiness, dry nose
- Contraindications: People with poor ventilation
digoxin
Method of Action:
Uses:
Side effect
Contraindication
- Method of Action: Block the Na+/K+ pump on the membrane of cardiac cells affecting contractibility, also stimulates the vagus nerve
- Uses: Arrhythmia (typically atrial fibrillation)
- Side effect: Dizziness, nausea, vomiting
- Contraindications: Previous MI, severe bradycardia, severe heart failure
•
•Derived from the foxglove plant
potassium channel blockers
Method of Action:
Uses:
Side effect
Contraindication
example:
- Method of Action: Block potassium channels to alter cell membrane potentials
- Uses: Arrhythmia (Class 3 antiarrhythmic)
- Side effect: Perioral paraesthesia, light-headedness, nausea, anxiety and epigastric distress.
- Contraindications: Xerostomia and formation of a new arrhythmia
- Example: Amiodarone and Dofetilide
Describe what the P wave of the cardiac cycle marks
This marks atrial depolarisation, so atrial contraction. Here the blood is forced into the ventricles.
Describe what the QRS complex of the cardiac cycle marks
This marks the depolarisation and contraction of the ventricles.
Here the mitral and tricuspid valves are closed and the pulmonic and aortic valves are open leading to blood leaving the heart.
Describe what the T wave of the cardiac cycle marks
This marks the repolarisation of the ventricles returning the heart to its resting state.
what is the healthy range of bpm
60-100bpm
where should the BP cuff and stethascope be placed when taking blood pressure manually?
- Place the sphygmomanometer (BP cuff) on the arm about 3cm above the cubital fossa and ensure it fits snugly
- Place the stethoscope over the brachial artery near the cubital fossa
what is hypertension?
cause:
symptoms:
diagnosis:
treatment:
Defined as having a blood pressure of greater than 140/60, either of these numbers can be raised but if both are it is termed ‘raised pulse pressure’
Cause:
- Primary: An idiopathic condition controlled by risk factors such as stress, age, smoking and alcohol consumption
- Secondary: Hypertension as a result of other conditions such as diabetes, kidney disease and pregnancy
Symptoms: Asymptomatic but is a risk of many other cardiac conditions
Diagnosis: Blood pressure monitoring
Treatment:
- Primary: Risk factor reduction and medication such as ACE inhibitors, ARBs, Diuretics (typically potassium sparing), Calcium channel blocker, Beta blocker and Potassium channel opener
- Secondary: Treat the condition causing the hypertension
what is malignant hypertension?
cause:
symptoms:
treatment:
blood pressure of greater then 180/120 and typically only occurs for a short period of time
Cause: Typically due to the patient taking antihypertensive medication for a long time then suddenly stopping their doses, as well as being caused by some adverse drug reactions
Symptoms: Chest pain, Dizziness, Headache and Loss of Consciousness
Treatment: Typically admitted to hospital and given IV antihypertensives
what is the dental relevance of hypertension?
- do not treat patient if BP over 160/110 (malignant hypertension)
- can give patient adrenaline
- increased post op bleeding
- medication can cause dry mouth
- white coat syndrome may present
what are the causes of heart failure?
- Volume overload (valve disease leading to backflow of blood)
- Pressure overload (Long term hypertension)
- Disease (Viral myocarditis, infective endocarditis)
- Arrhythmia
- Ischaemic heart disease
- Risk factors such as smoking, alcohol intake and obesity
describe heart failure-
symptoms:
diagnosis:
treatment:
Symptoms: Oedema of the legs (Right ventricle failure), Oedema of the lungs (Left ventricle failure), muscular atrophy, dyspnoea, orthopnoea, fatigue, heart palpitation and cyanosis of the lips and fingertips
Diagnosis: An ECG, chest x-ray, coronary angiogram and cardiac CT scans
Treatment: Risk factor modification, antihypertensive drugs, ionotropic drugs, biventricular pacemakers (to increase the efficiency of pumping) and at late stage disease a heart transplant
what is the dental revelance of heart failure?
- orthopnea
- breathlessness when lying flat
- medication can cause dry mouth
- danger with ultrasonic scalers interacting with pacemakers
- may be on immunosuppressants
what is ischaemic heart disease?
cause:
symptoms:
diagnosis:
treatment:
A disease where the heart muscles do not receive the amount of oxygen they require
Cause: Formation of an atheroma initiated by risk factors such as hypertension, alcohol intake, cholesterol level, obesity and diabetes
Symptoms: Fatigue, Dyspnoea, Headache, Dizziness, Jaw Fatigue and Chest pain that travels down the left arm (Angina Pectoralis)
Diagnosis: ECG, coronary angiography and cardiac CT scan
Treatment: Modification of risk factors and Medication such as Antiplatelet drugs (Aspirin), Antihypertensives, Statins (to reduce cholesterol) and Nitrates (to increase blood flow to the heart).
- As a last resort the surgical treatments of an angioplasty and placement of a stent can be carried out.
what is the dental relevance of ischemic heart disease?
- stable angina can be treated with LA (2 cartridges max)
- should not treat people with unstable angina
- keep appointments short to prevent acute exacerbation of symptoms due to stress
- follow guidelines of anticoagulant medication
- pt may present with symptoms
- fatigue
- jaw claudication
- pain in jaw when eating
- medication side effect : dry mouth
what is an atheroma?
build up of material that adheres to the arteries
describe the formation of an atheroma
- disruption of vessel wall -> cholesterol accumulates there and oxidises. This causes an inflammatory response
- macrophages flock to area and take up cholesterol -> they become foam cells
- foam cells fill sub endothelium and die, releasing their contents and forming the atheroma
- this disrupts the membrane -> scar tissue formation and accumulation of calcium ions which forms a hard plaque
- this leads to narrowing of vessel wall and increased blood pressure
- if in heart -> IHD
- if in other vessels -> peripheral vascular disease
- endothelium over plaque ruptures -> exposes collagen -> detected by blood cells -> platelet plug formation
- fibrin clot formation -> traps red blood cells -> creates a thrombus
- thrombus can break off and block a smaller vessel - causes myocardial infarction or stroke
what is infective endocarditis?
cause?
who are the high risk groups?
symptoms?
diagnosis?
treatment?
a bacterial infection of the endocardium leading to inflammation and formation of vegetations on the valves?
cause: bacteria entering the blood stream and trvaelling to the heart
High Risk Groups: Previous infective endocarditis, congenital heart defects, have had a valve replacement, or are an IV drug user
Symptoms: Fever >38℃, splenomegaly, finger clubbing, murmur formation, petechial rash and septic emboli (which can travel to the brain and cause a stroke)
Diagnosis: Take a blood culture and look for bacteria
Treatment: Antibiotics and Prophylactic cover during dental treatment for high risk individuals
what is duke criteria?
set of diagnostic criteria for the diagnosis of Infective Endocarditis
- Positive blood culture
- Presence of vegetations on an ECG
- High risk (see below)
- Have a fever of >38℃
