Cardiovascular Flashcards
pulmonary circulation
right side of the heart, which carries blood from the heart to the lungs and back to the heart
systemic circulation
left side of the heart, which carries blood from the heart to the rest of the body and then back to the heart
atherosclerosis
cells and lipids accumulate within the tunica intima not on the artery walls
hypertension can lead to
hypertiensive heart disease
two basic types of coronary heart disease
chronic ischemic heart disease
acute coronary syndromes
chronic ischemic heart disease
stable angina
silent myocardial ischemia
acute coronary syndromes
unstable angina
acute myocardial infarction
sudden death
ventricular fibrillation
coronary heart disease medication side effects
xerostomia
calcium channel blockers (gingival hyperplasia)
antithrombotic treatment regimen: anticoagulant/antiplatelet therapy (excessive bleeding)
peripheral artery disease
atherosclerosis of the arteries in the lower extremities
dental implications peripheral artery disease
if taking anticoagulants, know the coagulation status
side effects of other meds
patient education
evaluate for perio disorders
possible referral
abdominal aortic aneurysm
weakness of the aorta causing an enlargement or bulging of the artery
aneurysm located in abdominal aorta
abdominal aortic aneurysm dental implications
side effects of medications
stress importance of maintaining healthy oral tissue
identification of individual at risk may prompt a medical referral
raynaud disease or phenomenon pathogenesis
ischemia caused by vasospasm in the vessels of the extremities and sometimes ears and nose
brought on by cold or emotional stress
associated with smoking
raynaud disease or phenomenon dental implications
refer for medical evaluation
side effect of medications
thromboembolic venous disorders
formation of blood clots
can break away and lodge anywhere
deep vein thrombosis (DVT)
dental implications of thromboembolic venous disorders
low dose anticoagulant therapy (no risk of blood loss)
stronger anticoagulants (increase the risk of uncontrolled bleeding)
medical consultation to determine coagulation status
local hemostatic measures
common blood thinners
warfarin
eliquis
xarelto
pradaxa
heparin
2 forms of stroke
ischemic - thrombus/embolus
intracranial hemorrhage - trauma, hypertension, aneurysm
pathogenesis of stroke
blood obstructed by growing thrombus, or by an embolus
tissues distal to obstruction become damage and necrotic
resulting pressure in cranium due to blood flow causes an interruption of blood flow to tissues
perioral and intraoral characteristics after stroke
unilateral weakness may affect: chewing, swallowing, ability to clear the mouth of residual food
uncontrollable drooling
favor chewing on unaffected side of mouth
food pocketing
motor impairment
dental implications of stroke fall into four categories
management of side effects of meds
management of post stroke physical effects
home care modifications
emergency management of stroke
dental implications of stroke - management of side effects of meds
determine coagulation status
provide local hemostatic measures
avoid tissue trauma
xerostomia management
calcium channel blockers may cause gingival overgrowth
knowledge of heart disorders will enable the dental professional to
recognize potential problems
modify the treatment to protect the patient and provide the safest possible therapy
shunts cause
mixing of oxygenated and deoxygenated blood
ventricular septal defect
hole in septal wall between left and right ventricles causing mixing of blood
higher risk for infective endocarditis, aortic valve prolapse and blood clots
eventual congestive heart failure
clubbing of fingertips
fatigue, shortness of breath and tachycardia
finger clubbing is an important feature with
chronic hypoxia
cyanosis
atrial septal defect
hole in the wall between the right and left atria
cyanosis and hypoxia
abnormal heart beats (dysrhythmias)
clubbing of fingers
higher risk for infective endocarditis and emboli
patent ductus arteriosus
ductus arteriosus does not close after birth
premature babies
heart murmur
development of pulmonary hypertension
higher risk for infective endocarditis and arteritis
pulmonary stenosis
narrowing of pulmonary valve
caused by a fusion of the valve cusps
forming a funnel when the valve opens instead of a wide opening
if severe- will be difficult for the heart to pump blood into the lungs
CHF may result
tetralogy of fallot (TOF)
4 defects: VSD, PD, overriding aorta, and right ventricular hypertrophy
right to left shunting of blood, cyanosis and hypoxia
shortness of breath
polycythemia - abnormal increase in the number of red blood cells
increased risk of infective endocarditis, emboli, brain abscesses, acute episodes of cyanosis during which seizures, loss of consciousness and sudden death are possible
coarctation of the aorta (COA)
constriction of the aorta
BP and pulse in the upper body differs compared to the lower body
lower volume of blood is able to get past constriction
left ventricular hypertrophy, dizziness, headache, epistaxis
weakness, pain, pallor and coldness in lower extremities
arteritis at constriction site
untreated - increase risk for stroke, ruptured aortic and cerebral aneurysms, infective endocarditis at the aortic valve
transposition of the great arteries (TGA)
aorta exits from right ventricle and pulmonary artery exits from left ventricle
most times also septal defect
if no septal defect to allow for mixing of blood then is fatal
cyanosis and hypoxia
dental implications of congenital heart defects
presence of cyanosis should have medical investigation prior
treatment modifications - prophylactic antibiotics
supplemental oxygen
stress reduction techniques
caution administering local anesthetics
patients ed - link of oral infection and bacterial endocarditis
how adequate OH can decrease the risk of an autogenous infection
dental antibiotic prophylaxis
antibiotic given to a patient for prevention of harmful consequences of bacteremia that may be caused by oral flora
heart valve defects
narrowing of heart valves
muscles of heart have to compensate
insufficient heart valves do not close all the way, causing regurgitation
muscles will compensate to try to push more blood through
blood flow through valve is more turbulent causing more damage
heart eventually weakens and congestive heart failure will result
two kinds of heart valve defects
benign/physiologic murmurs
pathologic murmurs
pathologic murmurs
caused by valve defect
stenotic valves - symptoms manifest when the heart is under stress
shortness of breath, possible chest pains
benign/physiologic murmurs
mostly heard in small children
grow out of, no treatment needed
no risk for endocarditis
heart valve defects dental implication
daily home care could cause bacteremia
bacteria within the blood to attach to endocardium
no prophylactic antibiotics for physiologic heart murmurs
anticoagulant therapy (xerostomia)
individuals with valve replacement are at a high risk for bacterial endocarditis and thrombus formation (may be on prophylactic antibiotics, augmented antibiotic prior to, consultation with patient’s physician)
mitral valve prolapse dental implications
the ADA no longer requires prophylactic antibiotic coverage with or without regurgitation
education should be given to patients on the importance of decreasing the risk of creating a bacteremia that might result in infective endocarditis
rheumatic heart disease dental implications
patients may be on anticoagulants
patients may be on daily antibiotics
should be suspected for patients reporting a history of rheumatic fever (at risk for recurrence, which could cause more heart damage)
infective endocarditis etiology
bacteria (staphylococcus and streptococcus)
gram negative bacillus, yeast, fungi
bacteremia must be present
can form in a healthy heart, but develops most often in a heart compromised
infective endocarditis peri/intraoral characteristics
petechiae may be found on any of the oral mucosal surfaces, especially soft palate and buccal mucosa
infective endocarditis extraoral characteristics
fever, chills, shortness of breath, could have low grade fever and flu like symptoms
dental implications of infective endocarditis
prophylactic antibiotics prior to dental treatment
gingival and periodontal infections are the most common source of transient bacteremia
identify persons at risk
congestive heart failure perioral and intraoral characteristics
cyanosis of the lips and oral tissues
severe: right side jugular vein may become distended and can be observed when patient is in an upright position
dental implications of congestive heart failure
xerostomia because of medications for CHF
modifying the chair to a semi-upright or upright might be indicated as well as supplemental oxygen to aid in breathing
dysrhythmias
abnormal heart rhythms or beats
tachycardia
fast heartbeat
bradycardia
slow heartbeat
dental implications of dysrhythmias
often able to identify abnormal heart rhythms
refer to physician
implanted pacemakers or defibrillators do not indicate the need for prophylactic antibiotic coverage
careful using magnetostrictive devices around unipolar pacemakers
bipolar and ICD
