Cardiovascular Flashcards
What is the main cause of vascular disease in the developed world?
Atherosclerosis
What is Atherosclerosis?
Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery walls
Non modifiable risk factors of atherosclerosis
older age
family history
male > female
Modifiable risk factors of atherosclerosis
smoking
alcohol
poor diet
obesity
stress
diabetes mellitus
Systolic
Heart pumping
Diastolic
Heart relaxing
HBP reading
> 140/90 or 150/90 if >80yrs old
Normal blood pressure reading
<120/80
Diseases caused by atherosclerosis
Cerebrovascular disease (brain)
Ischaemic heart disease (heart)
Mesenteric ischaemia (gut)
Renovascular disease (kidney)
Abdominal aortic aneurysm (aorta)
Peripheral vascular disease (legs)
Primary prevention
for patients that have never had cardiovascular disease in the past.
QRISK3 score calculates the percentage risk of the patient having a stroke in the next 10 yrs. If >10% risk offer a statin. If patient has chronic kidney disease or type 1 diabetes for >10 yrs offer atorvastatin.
Secondary prevention
for patients that have had angina, myocardial infarction, TIA, stroke or peripheral vascular disease.
4 As:
A - Aspirin (plus a second antiplatelet such as clopidogrel for 12 months)
A - Atorvastatin
A - Atenolol (or other beta-blocker – commonly bisoprolol) titrated to maximum tolerated dose
A - ACE inhibitor (commonly ramipril) titrated to maximum tolerated dose
How long should you avoid dental treatment post myocardial infarction
4 weeks - check with GP before treating
Drug impact on oral cavity - ACE inhibitors
Oral lichen planus
Drug impact on oral cavity - Nicorandil
Chronic painful ulcers
Drug impact on oral cavity - Calcium channel blockers
Gingival hyperplasia
Sinus rhythm
Normal cardiac rhythm
On an ECG: P WAVE
Atrial depolarisation
On an ECG: QRS WAVE
Ventricular depolarisation
On an ECG: T WAVE
Ventricular repolarisation
Arrhythmia
Abnormal cardiac rhythm
What is classed as too fast a heart beat?
> 100/minute
What is classed as too slow a heart beat?
<60/minute
Atrial fibrillation
Irregular
Tachyarrhythmia
Too fast
Bradyarrhythmia
Too slow
Ventricular arrhythmia
- Ventricular tachycardia
- Ventricular fibrillation
Peripheral vascular disease
Atherosclerosis effecting peripheral vessels
- lower limbs
- abdominal aorta
Critical limb ischaemia
Serious form of PVD.
Embolus or atherosclerotic plaque rupture
Claudication
Pain in the legs or arms that occurs while walking or using the arms. Usually a symptom of PVD
Management of PVD
- Risk factor modification
- Exercise programme
- Surgery
> Bypass grafts
> Stents
> Amputation
Abdominal aortic aneurysm
Damage to vessel wall from atherosclerosis causing a dilated aorta
What is the UK screening age for men
> 65 yrs old
Medical management of Ischaemic heart disease
- Pericutaneous coronary intervention (stents)
- Coronary artery bypass grafting - open heart surgery
GTN dosage
2 sprays, sublingually, 5 mins apart, up to 3 doses
What side of the heart is most commonly effected by valvular heart disease?
Left
- Aortic valve
- Mitral valve
Pathophysiology of valvular heart disease: regurgitation
- Loss of valve integrity
- Becomes floppy
- Leaks
- Can cause heart failure
Pathophysiology of valvular heart disease: Stenosis
- Narrowing of valve
- Obstruction of flow
- Inadequate output
- Can cause heart failure
Treatment for VHD
Medication
Surgery - valve replacement
Dental aspects of VHD
Anticoagulation due to warfarin etc
Risk of infective endocarditis due to invasive procedures
Congenital Heart Disease
term used to describe a range of birth defects that affect the normal way the heart works.
The term “congenital” means the condition is present from birth.
Types of congenital heart disease
- Atrial septal defect
- Ventricular septal defect
- Patent ductus arteriosus
- Coarctation of the aorta
- Tetralogy of Fallot
Atrial septal defect
- hole in atrial septum
- not at increased of endocarditis
Ventricular septal defect
- hole in ventricular septum
- at increased risk of endocarditis
Patent ductus arteriosus
- duct arteriosus is part of foetal circulation
- usually closes at birth
- at increased risk of endocarditis
Coarctation of the aorta
- narrowing of the aorta at the site of the ductus
- at increased risk of endocarditis
Tetralogy of Fallot
- VSD
- Pulmonary stenosis
- RV hypertrophy
- over riding aorta
- at increased risk of endocarditis
Dental aspects of CHD
- risk of infective endocarditis unless it is an isolated
- if severe can have problems lying flat
Infective endocarditis
Usually occurs on diseased or prosthetic valves
An infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel
Infarction
No blood is getting through at all - tissue death
thrombus
a blood clot that forms in a vessel and stays there
example of an ACE inhibitor
rampipril
example of an Angiotensin II antagonist
valsartan
example of Diuretics
Bedroflumethiazide
example of a calcium channel blocker
amlodipine
example of a beta blocker
bisoprolol
The American Society of Anaesthesiologists patient classification states;
“globally assess the degree of …. or …. prior to selecting anaesthetic or performing surgery”
sickness
physical state
how is atrial fibrillation controlled
drugs - anticoagulants
where in the body may you find a pacemaker?
left upper chest wall, below the clavicle
Supraventricular tachycardia (SVT)
An arrhythmia originating above the ventricles (either atria or AV node)
Emergency treatment for tachyarrhythmias
vagal manoeuvres, carotid sinus massage, drugs
Prevention treatment for tachyarrhythmias
drugs
surgery
treatment for ventricular arrhythmias
start CPR
rapid defibrillation
phone 999
longer term treatment - drugs and ICD (Implantable Cardioverter Defibrillator
5 Ps of critical limb ischaemia
Pale
Pulseless
Perishing cold
Paralysis
Paraesthesia of limb (pins and needles)
What is intermittent claudication
muscle pain that happens when you’re active and stops when you rest
