Cardiovascular 2 Flashcards
what is hypertension?
damage to blood vessels after a certain BP
what is stage 1 HT?
BP persistently between 135/85 mmHg and 149/94mmHg
Stage 2 HT?
BP persistently > 150/95 mmHg
stage 3 HT?
systolic BP >180mmHg or diastolic >120mmHg
call 111
potential organ damage
malignant HT?
systolic BP >220mmHg
call 999 medical emergency
give a list of the consequences of high BP
what happens to the blood vessel walls with HT?
damaged and thickened eg. arterioles thickened therefore smaller diameter lumen with increased Peripheral resistance therefore increase BP
which organs are at risk of HT?
ones with lots of tiny vessels eg. kidneys and eyes can lead to chronic kidney disease and hypertensive retinopathy
name the condition when we have chronic HT affecting kidneys
chronic kidney disease
name the condition when we have chronic HT affecting eye?
hypertensive retinopathy
what can increase the risk of aneurysms, atheromas and peripheral vascular disease?
- tough collagen and ca deposits on artery walls which makes them stiffer and less able to stretch with each pulse therefore can cause more damage to walls
how can HT lead to heart failure ?
high BP in aorta needs a higher pressure in left ventricle to push blood into it - ventricular hypertrophy
what the organs can be affected by HT?
brain eg. strokes and seizures
heart itself eg. acute cardiac ischemia
give an overview of the causes of hypertension?
how can we address obesity?
- diet and exercise
- need to advise pt of risks
- goes hand in hand with diabetes which also increase risk of HT
addressing alcohol?
- should advise pt of drinking too much and affect on BP
how does sodium play a role in HT?
- Body removes salt through kidneys and water in blood follows –> reduces venous return, CO and BP
- so high salt diet = increases water retention therefore –> high BP
how does smoking play a role in HT?
Chemicals in ciggs impair vasodilation and causes atherosclerosis, stiffening vessels and increasing BP
how does stress affect HR?
- thru sympathetic fight or flight response which functions to increase BP
how do kidney and endocrine diseases cause HT?
- salt excretion and hormones ie. renin angiotensin system (long term control) are controlled by the kidneys
- kidney diease can cause HT and other endocrine disorders
what other endocrine disorders cause HT?
- those that cause increase in catholamines
- cons syndroms
- pheochromocytoma
what’s important to note about medications?
- can deliberately or give an unwanted side effect that cause high BP or their medications can interact with each other and prevent an antihypertensive from being affective
list the drugs for HT
how do diuretics decrease HT?
increase excretion of fluid via kidneys by reducing circulating vol an lower BP
what are the 2 ways ACE inhibitors reduce HT?
- inhibit ACE enzyme therefore prevents formation of angiotensin 2 therefore decrease BP
- also stops bradykinin from breaking down which is a vasodilator ( can cause dry cough or angeodema )
- ACE inhibitors usually end in - april
what happens as result of bradykinin breaking down ?
can cause dry cough or angiodema (facial swelling
whats the alternative medicine to ACE inhibitors ?
angiotensin receptor blockers
ends with - sartan
how do angiotensin receptor blockers work?
block angiotensin at site of action
how do ca channel blockers work?
- prevent vasoconstriction and reduce the rate and force of heart beat as its all ca dependant
- therefore reducing muscle contraction
how do beta blockers work?
- end in olol
- prevent HR and SV from rising too high by blocking sympathetic pathways
- they decrease rennin release
what 2 rarely used drugs block the SNS?
clondinin and methyldopa
how do alpha blockers work?
cause vasodilation
how do we manage pt who have HT in practice?
- Think about the potential side effects of their meds eg. prone to postural hypertension hypotension (stand up and get dizzy) therefore we advise pt to get up slowly
- use LA rather than general
give the timeline of the formation of atherosclerosis ?
1) Fatty streak - due to lipid builup în tunica intima
2) Collagen deposition follows- makes walls stiffer
3) Fibrolipid plaque - a fibrotic cap forms over the fatty streak (cap can be damaged by high BP eg. due to HT and bifurcations (blood is usually more turbulent) of arteries or wiggly areas )
4) can progress into complicated fibrolipid plaque if cap gets damaged
5) thrombosis - mass of platelets and RBC and fibrin that sit on vessel walls due to sticky blood for the way the blood flows, damage to walls, turbulence, bifurcations ie VIRCHOWS TRIAD
what link does atherosclerosis, and its outcomes like coronary heart disease, have with periodontal disease?
- their is a correlation due to underlying factors such as how your bodies’ tendencies to fight off inflammation and cytokine endotoxin release.
what happens when we have reduced blood flow to an organ
ischemia
what happens when the tissue dies as a result of reduced blood flow
infarction
what is a thrombus called when it breaks off ?
embolus
what does the embolus do?
travels thru blood stream until lodged in a vessel with a small enough diameter that it blocks blood flow - leads to infraction
what do symptoms of thrombus depend on?
location of the thrombus or embolism
what causes acute cardiac ischaemia?
reduced perfusion via the coronary artery ( or severe hypotension or severe anaemia that reduced 02 capacity to heart but rare)
how does ACI feel?
- crushing pain and tightness due to spinal level of nerve that supplies the heart ( spinal level also supplies to other parts of body)
-BUT not all pt experience pain in the same area
what is it called when the body misinterprets heart damage as pain coming from somewhere else in body?
referred pain
where else can pts feel pain when experiencing ACI?
neck jaw arm and back
What happens when perfusion to heart becomes significantly less
cell death
How can we identify if ACI has progressed to ACS?
THE DRS acronym
what is stable angina an example of?
cardiac ischemia
what is ACS an eg of?
infraction or very soon
what happens when cells in heart are damaged or die?
unable to contract
affects less SV, CO and perfusion to other organs
signs and symptoms of ACI
how does breathlessness occur in ACI?
trying to compensate lack of oxygen at other organs
- pressure can also buildup behind heart in pulmonary side of circulation ie pulmonary vein= can cause fluid to leak out of blood vessels in lungs = pulmonary oedema
how does pulmonary oedema occur in ACI?
pressure can buildup behind the heart in pulmonary side of circulation ie pulmonary vein which can cause fluid to leak out of vessels in the lungs
what signs and symptoms can show that one has fluid buildup in the lungs with ACI?
hypoxia and cyanosis (blue fingertips or mouth) as there is a reduction in the efficiency of gas exchange
how does lightheadedness affect us during ACI?
reduced perfusion to brain from effected CO due to heart damage
low bp
*the SNS will try to increase HR and SV to maintain CO and BP which can make us clammy
why will some pts look sweaty but cool to touch in ACI?
peripheral vasoconstriction = constriction in less essential areas to redirect circulating volume to more essential organs
why do we feel nauseous during ACI?
- SNS is responsible
why do pts feel palpitations during ACI?
cardiac damage can result in abnormal electrical rhythms or irregular heartbeat
how can you check if a pt has aarrhymia or heart palpitations ?
take a manual pulse
what are the steps for when someone is having ACS?
what is aspirin?
antiplatelt which prevents blood form clotting further
what does a GTN spray do?
vasodilator that dilates coronary artery and increase blood flow in heart
- it can also dilate other arteries in body too therefore reduces BP
- so check BP is above 90 sys before giving GTN
- if BP drop critically below 90 = cardiac arrest rather than just myocardial infarction
once pt arrives at hospital what will most likely be done?
ECG and blood test
what does ECG tell us?
may distinguish infarction from ischeamia as dead cells can disrupt electrical activity
what does troponin in blood mean ?
dying heart cells
what are the ways in which we can manage coronary artery disease ? (2)
unblock coronary artery
- chemical thromobolysis eg. streptokinase
- manual eg. angioplasty
- replace vessels eg. coronary artery bypass graft
how does angioplasty work?
- inflating a balloon inside the vessel to open it up
- place stent to open it up
- remove blood clot
what will pts have to take longer term after CAD ?
- statin- which reduces LDL cholesterol (fatty streak buildup)
- beta blocker and ace inhibitor - reduce strain on heart
- antiplatelet eg. aspirin (prevent clot buildup )
- anti coagulant given after immediate aftermath
what condition will a pt get after a heart attack ?
arrhythmia due to scar tissue interrupting normal flow of electricity and risk of heart failure due to damage
what can we advise as dentists to someone with coronary artery disease ?
why do we advise healthy diet and exercise ?
to lower body weight and prevent fatty streak formation
what are the 2 ways smoking affects ppl with CAD?
-athersocelroiss
- thrombosis
how does smoking lead to atherosclerosis ?
- impedes vasodilation
- free radicals from smoke inflame lining of vessels through oxidative stress
how does smoking lead to thrombosis ?
makes platelets stickier
stimulates clot formation whilst impairing clot breakdown
how does CO in smoke cause CAD?
reduces 02 carrying capacity of RBC
body makes more to compensate
this however makes blood sticky and thicker = clot
how should we deal with a pt that has angina?
book them in the morning to reduce their wait time if they’re anxious - emotional stress is a trigger for angina
what should we do if pt is newly diagnosed with angina ?
delay apt to ensure its well controlled
how do we deal with pts who have had a myocardial infacrtion within the last yr ?
delay elective dental tx
atherosclerosis can cause P——- v—— d—–?
peripheral vascular disease
what is PVD also known as ?
peripheral arterial disease
what is PVD?
build up of fatty deposits in arteries restricts blood supply to leg muscles.
what do ppl with PVD experience?
claudication - pain when walking
can settle with rest
what can severe critical ischemia lead to?
arterial ulcers, gangrene or pain that doesn’t go away with rest - these pt need urgent vascular surgeon appts to get their vessels replaced or dilated
how do we monitor PVD?
Compare BP of arms and legs = if similar - GOOD
- if less than 0.9 - diagnostic
- less than 0.5 - critical ischemia
what is critical ischaemia?
comes on chronically and reaches to the point that the pt is in pain at rest
what is acute ischemia ?
emergency
leg becomes suddenly ishceemiac
how can we recognise acute ischemia ?
6 P’S
how quick does a pt with acute ischemia need to be treated before limb amputation?
4-6hrs
what are aneurysms caused by?
atherosclerosis
what can an anuerysm create?
a fistula into nearby vessels if it happen gradually or compress nearby structures
what condition is shown in the pic below
abdominal aortic aneurysm
what happens if an abdominal aortic aneurysm ruptures?
abdominal pain, cardiovascular collapse
what is the mortality rate?
50%
how are pts with AAA managed?
- surgerically fixed once it reaches a certain size before rupture
- monitored
- long term radiological follow ups
what are varicose veins?
swollen veins in legs
due to incompetent valves in veins
can be painful
skin changes eg. itching swelling
what are venous ulcers?
- looks less punched out
- use of compression bandages
what are embolisms?
- clot that can lodge anywhere
what happens if we have a pulmonary embolism?
plerutic chest pain?
sharp inhale due to membrane of lungs rubbing together
how do we diagnose a pulmonary embolism?
CT scan w/ contrast in veins to see where blockages are
how do we treat pulmonary embolism?
blood thinners
who do we give prophylaxis to to prevent a DVT?
pts who are bed bound
what are mechanical prophylaxis ?
TED stockings (bandages)
