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4th Yr - CMS 1 > Cardiovascular 3 > Flashcards

Cardiovascular 3 Flashcards

1
Q

when we check a pulse what are we looking for?

A

rate rhythm and character

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2
Q

what is a regular pulse called?

A

sinus rhythm

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3
Q

what is an arrhythmia ?

A
  • irregular heartbeat starting elsewhere or a problem with circulatory of the heart
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4
Q

what are the causes of arrhythmias?

A

congenital, scar tissue or electrolyte imbalance

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5
Q

what is the condition called when there’s a fast heartbeat coming from the atria or AVN?

A

Supraventricular tachycardia (above ventricles)

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6
Q

what is a fast irregular heartbeat called?

A

atrial fibrillation

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7
Q

name the condition where tachycardia originates from ventricles?

A

ventricular tachycardia

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8
Q

what happens if the pt experiences irregular chaotic heartbeat specifically from the ventricles ?

A

ventricular fibrillation leading to cardiac arrest

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9
Q

what does cardioversion do?

A

tachyarrhythmia can be reversed by cardioversions which delivers a shock to rest the heart.

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10
Q

what is the success rate for cardioversion ?

A

low as it sometimes doesn’t work therefore pt needs med to maximise the time that the heart has to refill between beats

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11
Q

what is a bradyarrhytmia?

A

slow irregular heartbeat

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12
Q

give egs of bradyarrhythmia

A

sinus bradycardia
sick sinus syndrome
heart block
ventricular escape

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13
Q

what is a heart block?

A

-conduction issue at AVN or bundle of his
- causes excessive delay between atrial and ventricular conduction (contraction) hence causes a slow beat

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14
Q

what happens if there’s no conduction? what is it called?

A

ventricles have their own slow regular rhythm - ventricular escape

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15
Q

what is the CO like in a Bradyarrhythmia ?

A

low due to low heart rate

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16
Q

what is CO like in tacharrhytmia?

A

low due to reduced stroke volume

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17
Q

Location of AF?

A
  • rhythm of the heart originating somewhere in the atria but not SAN
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18
Q

how does AF occur?

A
  • discoordinated fibrillation at atria with some electricity conducted down to ventricles but not all of it as its too fast and the time needed for cells to repolarise before being able to conduct another impulse leads to some of electricity conduction down to ventricles - irregular pulse
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19
Q

describe the blood flow of someone that has AF?

A

clots more

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20
Q

if someone with AF has a clot formation which moves into circulatory system, where will this clot go to first?

A

brain leading to stroke

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21
Q

what will someone with AF be prescribed with?

A

anticoagulant (DOAC)
used to be warfarin

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22
Q

what is a DOAC?

A

direct oral anticoagulant

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23
Q

how do DOAC’s work?

A

different mechanism on where it acts in Coagulation cascade depending on the drug

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24
Q

compare DOAC to warfarin

A
  • DOAC doesn’t need monitoring whereas warfarin does (need to get regular blood tests to make sure u have right level of anticoagulants)
  • food interactions with W
  • DOAC is more stable
  • DOAC isn’t easily reversed compared to W (need to keep in mind if procedure has high bleeding risk)
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25
Q

why is rate control important in a fast atrial fibrillation?

A
  • to allow heart to have time to fully refill and preserve SV and CO
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26
Q

list all the anti-dysrhythmic

A

Class 1,2,3,4 and glycosides

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27
Q

how do class 1 drugs work?

A

stabilise the membrane eg. procainamide, quinidine, lidocaine, flecainide

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28
Q

how do class 2 drugs work?

A

beta blockers eg. bisoprolol

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29
Q

how do class 3 drugs work?

A

acts on potassium channels eg. amidarone

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30
Q

how do class 4 drugs work?

A

ca channel blockers

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31
Q

give an eg of glycosides

A

digoxin

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32
Q

when would we avoid certain LA’s like bupivacaine (cardio toxic) ?

A
  • if pt is on anti arrhythmic meds
  • have loads of side effects
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33
Q

syncope?

A
  • temp reduced perfusion to the brain
  • a drop in CO
  • type of loss of consciousness
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34
Q

what are the 2 types of syncope?

A

bengin and red flag

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35
Q

compare benign and red flag

A
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36
Q

what happens if someone has a red flag syncopal episode ?

A

call 999

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37
Q

stenosis?

A

heart valves become stiff
can’t open as well
heart has to beat forcefully to fight resistance

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38
Q

regurgitation?

A

valves become floppy
blood goes backwards thru the valves
blood ejected more than once thru changer due to regurgitation
blood
therefore larger volumes of blood for each heart beat
heart has to complete larger contraction to push onwards

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39
Q

what can valve disease be caused by?

A
  • older pt can have calfcfation causes stenosis papillary muscles become damaged eg. by cardiac ischemia = regurdtation
  • infection can damage valve wg. streptococcal can cause rheumatic fever immune response damages mitral valve causing stenosis regurgitation or both (one type of endocarditis)
40
Q

what is infective endocarditis?

A

caused by a number of diff infections bacteria will grow and damage valves

41
Q

why is I.E relevant to dentistry?

A

relevant to dentists as a number of oral bacteria are responsible for infective endocarditis
- these bacteria can make their way to heart by dental procedure that cause bleeding

42
Q

why don’t we give prophylactic antibiotics to prevent I.E for dental procedures ?

A

because brushing teeth or chewing with someone who has slightly inflamed gums cause same risk

43
Q

which pts are more prone to I.E?

A
  • this who alert damaged heart valves or artificial valves as bacteria likes to grow on these
  • hypertrophic myopathy or congenital heart defect
44
Q

how do we manage pts who are at a risk of I.E?

A

good OH
advise pts of other non dental procedure that can cause risk eg. tattoo, peircing
treart dental tx promptly

45
Q

what ar the signs and symptoms of I.E?

A

fever
weight loss
septic emboli
heart failure

46
Q

what are the signs of a septic emboli?

A

depends on site of emboli
splinter haemorrhage in nails - black streaks
blood in urine

47
Q

what is a septic emboli?

A

infectied material that moves into blood stream and blocks off blood vessel

48
Q

how do we treat septic emboli?

A

requires several weeks of intravenous antibiotics
or surgery to replace damaged valves

49
Q

how is valve disease generally treated?

A

replacing the damaged valve

50
Q

how do we replace valves ?

A
  • transcatheter aortic valve
  • non invasive
  • via catheter thru arteries
  • the new one pops open onto of old damages one so u don’t have to remove it
  • usually elderly ppl have had this
51
Q

myocarditis ?

A

muscles of heart inflamed

52
Q

pericarditis

A

inflammation of sac of heart (pericardium)

53
Q

what are the causes of pericarditis and myocarditis ?

A

infcetions
auto immune
drug rxns

54
Q

what are the risks with myocarditis and pericarditis?

A

arrhythmia
heart failure

55
Q

heart failure?

A

heart beats inefficiently

56
Q

what are the causes of heart failure?

A

hypertension
myocardial infarction
valve disease
arrhythmia
other diseases eg. cardiomyopathy

57
Q

what happens in hypertension that leads to heart failure ?

A

heart has to push against the higher pressure in the aorta - will become hypertrophied esp in left - thickens ventricle wall and reduces the amount of room in the left ventricle therefore reducing SV and CO - leading to heart failure and myocardial infarction

58
Q

what happens in a myocardial infarction that causes heart failure ?

A

heart muscle itself is damaged
so can’t pump as hard
will reduce SV

59
Q

what happens in valve disease that causes heart disease?

A

valve stenosis = hypertrophy
regurgitation = large vol of blood can dilate heart = weak contraction

60
Q

what happens in arrhythmias that eventually leads to heart failure?

A

heart can decompose eg. atrial fib due to chronically reduced SV

61
Q

how does cardiomyopathy lead to heart failure ?

A
  • disease in heart muscle or some lung disease can increase strain on heart muscle
62
Q

what is overload in terms of heart failure ?

A
  • when heart becomes too stiff and cannot refill or because its too weak to give full contraction
63
Q

list the symptoms of heart failure

A

fainting
tiredness
kidney disease
breathlessness (pulmonary oedema)
leg swelling
liver and spleen swelling
impaired gastric absorption

64
Q

how does fainting and tiredness work?

A

left side of heart affected, if its failing then body receives lower CO therefore lower BP

65
Q

how are the kidneys affected by heart failure ?

A

reduced perfusion to kidneys

66
Q

why do ppl with heart failure suffer from breathlessness (pulmonary oedema) ?

A

body receives less o2 from reduced perfusion to tissues and lungs will compensate

67
Q

why do ppl with heart failure suffer from leg swelling?

A
  • blood coming into LA back logs to lungs and causes pulmonary oedema
  • fluid leaves blood vessels due to backlog and it enters the lung tissue
  • pt becomes breathless as 02 exchange is impaired by the fluid that’s in the way, this is worse when pt lying flat as fluid covers greater SA of the lung
  • BEAR IN MIND WHEN GIIVNG DENTAL T x to pt if they have heart failure
68
Q

why do ppl with heart failure have liver and spleen swelling?

A
  • right side of heart failing so lungs receiving less blood to be reoxygenated therefore reducing oxygenated blood flow to whole body
  • this backlogs blood in systemic veins so we see swelling legs
  • can cause ulcers in legs and mobility issues due to loads of fluid in tissue
  • also increase risk of infections
69
Q

why do ppl with heart failure have impaired gastric absorption?

A

blood can back up to organs eg. liver and spleen = causes swelling and expansion fluid leaking from overloaded veins causes oedema in GIT can stop nutrient absorption as we have increased the wall between the gut and blood by putting loads fluid into it

70
Q

why do ppl with heart failure have abdominal distension?

A

if there’s fluid ascites leaking to abdominal cavity

71
Q

how do we treat heart failure?

A

lifestyle mod
medication
we cant reverse

72
Q

list all the pharmacological tx for heart failure

A

diuretics
ACE inhibitors
nitrates
beta blockers
digoxin

73
Q

what are diuretics?

A

reduce the volume overload in heart failure by increasing the amount of fluid that the pt urinates out

74
Q

if hypertension is a problem what do ace inhibitors , nitrates and beta blockers all do?

A

vasodilate to reduce the preload to the heart so heart is less overload

75
Q

what do beta blockers do if tachycardia is a problem?

A

slow the heart

76
Q

how do ace inhibitors and ARB’s work?

A

will increase the hearts strength of contraction

77
Q

what is digoxin and what does it do?

A

increase contractility whilst slowing the heart rate enough

78
Q

what happens if pharmacological tx is insufficient ?

A

we use a ventricular assist device

79
Q

what is a ventricular assist device ?

A

device that helps to mechanically push the blood around the heart
requires open heart surgery
requires bulky power source which is carried around and essential to stay alive
used as a precursor if someone is waiting for a heart transplant

80
Q

what can dentists do to help manage heart failure

81
Q

what is polyuria a side effect of?

82
Q

what is dry mouth a side effect of?

A

diuretics, ACE, Beta

83
Q

what is angiodema a side effect of?

A

ACE (because of their effect on bradykinin) , class 1 anti arrhythmia (procainamide, quinidine)

84
Q

what is hypokalaemia (low potassium levels in blood) a side effect of?

A

diuretics, note that hypokalaemia causes digitoxin toxicity

85
Q

what is glossitis a side effect of ?

86
Q

what is erythema multiform a side effect of?

87
Q

what is lichenoid run a side effect of?

A

thiazide diuretics, ACE, beta

88
Q

what is peri oral numbness a side effect of?

89
Q

what is facial pain a side effect of?

90
Q

what is bone marrow suppression (low platelets, bleeding, increase risk of infection) a side effect of?

A

captopril (type of ace)

91
Q

what is low Platelet count a side effect for?

A

prazocin, hydralazine, amidarone

92
Q

which drugs interact with NSAIDS

A

ace, angiotensin receptor blockers, beta and digoxin

93
Q

which drugs interact with LA?

A
  • diuretics (hypokalaemia)
  • ca channel blockers (hypokalaemia, also some slow recovery from midazolam)
  • beta blockers (hepatic toxicity, hypertension)
  • class 1 anti arrhythmics
  • digoxin (hypokalaemia thus toxicity)
94
Q

what interacts with erythromycin ?

A

anti arrhythmias (quinidine, amiodarone, digoxin)

95
Q

what interacts with some antifunglas ?

A

anti arrhymics (quinidine, digoxin)

96
Q

what is gingival hyperplasia a side effect of?

A

ca channel blockers

97
Q

what is taste disturbance a side effect of ?

A

ACE, angiotensin receptor blockers, ca channel blockers, amiodarone

4th Yr - CMS 1 (36 decks)

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