Cardiovascular 2 Flashcards
what is the most important risk factor in atherosclerosis
hyperlipidaemia
what are the 2 processes in atherosclerosis that result in disease
chronic inflammation and healing
describe chronic inflammation in atherosclerosis
high cholesterol damages the endothelial cells on blood vessels. these then increase their permeability to allow lipid and monocytes to move into the tunica intima. macrophages then engulf the lipid but cannot do anything with it. instead it forms foam cells
describe healing in atherosclerosis
cytokines then move to the site of inflammation, cause proliferation of smooth muscle, this then forms a fibrous cap over the foam cells. this is now known as an atheroma
how can chronic periodontitis be related to hypertension
the inflammatory markers produced in perio disease migrate to the liver and can increase systemic inflammation which increases atherosclerosis production
give an example of a chronic coronary condition
ventricular hypertrophy - caused by hypertension, pump has to pump harder against more resistance, heart muscle increases in size as myocytes proliferate, size of chamber decreases in size and blood flow to heart remains the same, becomes ischaemic
what kinds of valvular disease
insufficiency - failure to close
stenosis - failure to open
why might a blood vessel tumour appear in the elderly
haemangioma - hamartoma is congenital, bengin but as the mucosa thins with age it becomes apparent
what causes kaposi sarcoma and who is more vulnerable
human herpes virus 8, immunocompromised people especially HIV positive patients
what defines hypertension
raised blood pressure, higher than 140/90, take 3 measurements with 15 mins of rest between
what are some risk factors for hypertension
age - less elasticity, gender, genetics, obesity and diabetes
what is the result of hypertension
increased atherosclerosis, increases risk of heart problems, stroke and dvt. also can result in renal failure
what are the types of hypertension
essential - unsure of cause
renal - caused by renal stenosis, low blood flow to kidney, increases renin secretion to increase fluid retention
endocrine - tumour on adrenal gland, pressing on kidney and increasing cortisol secretion - increasing fluid resorption
what are the signs and symptoms of hypertension
usually none, may have a headache or TIA
what investigations can be done
urine sample - check electrolytes for reabsorption in kidney, check blood for creatinine, urea and cholesterol
how is hypertension treated
elderly - diuretics and calcium channel blockers
young - beta blockers and ACE inhibitors
what is heart failure defined as
heart unable to meet demands of body
what is the difference between high output and low output heart failure
high - when heart cant meet demands as demands are increasing, low - when heart cant meet basic demands
how can heart failure and hypertension be linked
heart failure - body thinks body has lost blood due to reduced output, increases blood pressure to counteract, this then makes heart failure worse
what might cause heart failure
damage to heart muscle - angina or MI
pressure overload - aortic stenosis, hypertension
arrythmias - atrial fibrillation, drugs - beta blockers, corticosteroids and anti-cancer drugs
what are the symptoms and signs for heart failure
depends on what side is effected
left - tachycardia, low HR, breathless, low bp
right - liver and gastrointestinal problems, oedema and ascites - increased venous pressure
how can heart failure be treated
reduce hypertension, treat valve disease or arythmias, positive ionotropes - digoxin
what is valve stenosis
blockage of heart valve, unable to open fully, backs up left ventricle which can affect pulmonary system
what is valve insufficiency
failure to close valves, get back flow into ventricle
what is the effect of valve disease
reduced cardiac output
what causes valve disease
heart muscle damage, mi or ischaemia, aortic aneurysm, cant cover full width, rheumatic disease, congenital
what is rheumatic disease
host produces antibodies against streptocci infection. these antibodies can attack the heart valves, lead to calcification of valves. infections can be caused by dental treatment or infections
how can valve disease be investigated
ultrasound, see the blood flow in real time, can see direction of travel of blood
what kind of heart valves can be used for replacement
porcine - pig valves, similar to human, but only last 10 years, dont need to be on anticoagulants, better for elderly or young children
mechanical - everyone else, needs to be on anticoagulants for life but can last a long time
what is tachycardia
increase of heart rate, atrial fibrillation
what is bradycardia
decrease of heart rate, induced by drugs eg beta blockers
what is ventricular fibrillation
still have electrical impulse but ventricle muscle is not contracting regularly, in MI or electrocuted, can be defibrillated reset SA node and heart muscle
what is atrial fibrillation
qrs complex is happening, bit irregular but no p wave, treated by anticoagulants
why might implanted pacemakers be used
in patients with bradycardia, sets a base line for electrical impulse for SA node, if it falls beneath this, pacemaker will pick it up and start firing, prevents heart rate getting so low than output results in unconsciousness
how might a dentist recognise heart failure
peripheral oedema if right side, on digoxin or if left side heart might be breathless lying back
describe infective endocarditis
streptococcus viridans into blood stream, can colonise cardiac valves (commonly mitral), causes vegetation, enlargement and surface abnormalities, this results in haemodynamic changes and turbulent flow, results in platelet aggregation - further vegetation of valve and heart muscle - heart valve and muscle damage
what patients are at risk of infective endocarditis
those who have had it before, those with congenital cardiac problems and those with valve replacement - porcine or mechanical
how did the guidelines for patients change regarding IE
used to be anyone remotely at risk would receive antibiotic prophylaxis for dental treatment - if had rheumatic fever or any cardiac problems - CABG, angioplasty - now it is more specific and less people get it
what changed with the 2016 NICE guidlines regarding IE
routinely - AP shouldn’t be given routinely, more up to the dentist and the physician if the patient should be given AP prior to treatment
what dental treatments are a risk for IE
anything manipulating dento-gingival junction - restorations are okay unless matrix band required, periodontal treatment, extractions are risk, endodontics should be okay
what should the focus be more for dentists to reduce risk of IE
reduce requirement for treatment - preventative measures, oral hygiene instructions, reduce bacteria in mouth
what are some disorders of haemophillia
haemophillia A - lack of factor VIII, sex linked recessive
haemophilia B - lack of factor IX, sex linked recessive
von wille brand disease - lack of factor VIII plus lack of platelet aggregation - autosomal dominant
what is the effect of a haemophilia disorder
inability to clot, prolonged bleeding time, risk of haemorrage
how is haemophilia A treated
carriers or mild disease - transexamic acid - slows down the break down of clot, DDAVP - vasopressin pulling factor 8 off of epithelial cells
moderate to severe - requires recombinant factor 8
how is haemophilia B treated
cannot use DDAVP as this is a factor 9 problem, all spectrums have to have recombinant factor for treatment, can use transexamic acid also
how is von wille brand disease treated
DDVAP and transexamic acid, more severe can receive recombinant factor 8
how are patients with bleeding disorders treated for dental
mild or carriers - minor oral surgery, periodontal treatment, extraction - requires hospital. local anaesthetic - buccal infiltration, intra ligamentary or intra papillary can be done in GDP but treatments requires IDB or lingual infiltration require hospital
moderate and severe - require hospital for everything, unless edentulous and only prosthodontics required - can be done in GDP
give examples of thrombophilia
congenital - protein c or s deficiency, anti thrombin 3
acquired - oral contraceptive pill, surgery, immobility after surgery, smoking, cancer
normally have a congenital problem without knowing, acquired on top
what is the consequence of thrombophilia
embolism, can block arteries - result in DVT or stroke or pulmonary embolism
how can you get for a palatelet problem
FBC - check platelet numbers
what can be done to check liver function in a patient with liver disease and what treatment can be given
pro thrombin time - PTT - checked in INR, should be 1. anything higher than this suggest lack of function. if liver disease, lacking many clotting factors, better to give fresh frozen plasma - replace all clotting factors
what is drug induced coagulopathy and what patients might experience this
inability to clot blood due to medication, normally on medication for atrial fibrillation, valve replacement, DVT or heart valve disease
what are the treatment guidelines for those on warfarin
check INR 48 hours prior to treatment but as close as possible, should be between 2-4. treat early in morning, aid homeostasis - vasoconstrictor with LA, sutures, pressure, if using LA avoid IDB if you can, can give it if required, provide good post op instructions including emergency contact
