Cardiovascular Disease

Question 1

What blood pressure value gives a diagnosis of hypertension?

Answer 1

140/90

Question 2

What are the types pf hypertension?

Answer 2

1 ) Primary = genetics, obesity, alcohol, smoking

2) Secondary = due to another disease leading to the hypertension such as renal disease, pregnancy, medications (OCP and corticosteriods)

Question 3

How do we treat the two different causes of hypertension?

Answer 3

Primary = weight loss, more exercise, better diet, reducing alcohol, increases fruit and veg intake

Secondary = we treat the primary cause

Question 4

Name the 5 class of drugs that someone with hypertension could be on

Answer 4

1) ACE inhibitor
2) Angiotension 2 receptor blockers
3) Beta blockers
4) Calcium channel blockers
5) Diuretics

Question 5

What is the dental relevance of hypertension?

Answer 5

• Minimise stress for the patient
• Delay treatments is blood pressure is over 140/90
• 180/110 needs to be an urgent referral to hospital
• Patients are likely to bleed more
• Patients are likely to be on aspirin which will affect wound healing
• Oral manifestations of medicines such as ACE inhibitors causing loss of taste and lichenoid reactions and calcium channel blockers causing gingival overgrowth

Question 6

What are the main sites for atheroschlerosis to occur?

Answer 6

• Aorta
• Carotid
• Coronary arteries
• Legs of diabetics

Question 7

How does an atherosclerotic plaque get into the tunica intima?

Answer 7

1) Entry of the LDL into the intimal layer (due to endothelial damage, hypertension)
2) LDl gets oxidised in the tunica intima and sends chemotaxis agents to blood monocytes
3) Monocutes then enter the tunica intima and ingest the LDL by attaching to them with receptors
4) Mass of macrophages containing LDL are now in the intima
5) Death of the lipid containing macrophages and spillage of the lipid into the endothelium

Question 8

What risk factors increase the chance of someone getting atherosclerosis?

Answer 8

• Family history
• Genetic predisposition
• Poor diet

Question 9

How does HDL inhibit the growth of an atherosclerotic plaque?

Answer 9

• HDL stops LDL oxidation
• HDL blocks the attachment of LDL to the endothelial layer to inhibit entry
• HDL blocks growth factors for lipid containing macrophages
• HDL can make platelets aggregation over the clot

Question 10

How can hypertension lead to atherosclerosis?

Answer 10

Hypertension damage to endothelial cells and facilitate pass of LDL into the tunica intima.

Question 11

Who does atherosclerosis affect?

Answer 11

• Affects makes
• Affects smokers
• Diabetes

Question 12

Why do we get ischemia or infarction from an atherosclerosis plaque?

Answer 12

• Collateral blood supply
• High speed of blood stops the organs adapting to less oxygen supply
• Metabolic needs of tissue
• Degree of arterial blocking

Question 13

What is ischemic heart disease?

Answer 13

Inadequate oxygen supply to meet demands of the heart due to a atheromatous plaque within coronary arteries.

Question 14

What are risk factors for ischaemic heart disease?

Answer 14

• Age
• Male
• Smoker
• Obesity
• Hypertension
• Diabetes
• OCP
• Stress

Question 15

What is angina?

What can we give a patient in the dental surgery?

Answer 15

Reduction in oxygen supply to the cardiac muscle leading to a strangling feeling in the chest.
GTN spray needs to be given to patient.

Question 16

What is the dental relevance of a patient having angina?

Answer 16

• Likely to be on aspirin (bleeding tendency)
• Likely to be on medications presenting orally
• If they are on calcium channel blockers they can get gingival overgrowth

Question 17

What is myocardial infarction and how can you manage this in a dental surgery?

Answer 17

Myocardial infarction = A continued reduction in oxygen to the heart leading to the death of heart cells.

Management:

• Sit patient up
• Calm approach
• Dial 999
• Give patient GTN spray (to prevent chest pain)
• Aspirin chewed
• Monitor pulse
• Give oxygen

Question 18

What is a thrombus and why is it a problem?

What 3 things lead to an intravascular thrombus?

Answer 18

A thrombus is where haemostasis occurs in the wrong place and the wrong time.

1) Change in the surface of the vessel
- Atheromatous plaque
- Loss of endothelial cell layer
- Frostbite damaging the endothelial cell layer
- Inflammation within the blood vessel wall
2) Changes in blood flow
- No blood moving leads to blood around values in the lower legs
3) Changes in the constituents of the blood
- No anti-coagulant blood
- Increase in pro-coagulant blood
- Increase in platelet count and adhesiveness

Question 19

What are the outcomes of a thrombus?

Answer 19

1) Lysis
2) Organisation/recanalisation (movement of clot through the vessel)
3) Embolism (formation of emboli) - until a vessel is reached whose lumen is smaller than that of the thrombus

Question 20

What happens in heart failure?

What are the symptoms of left and right heart failure?

Answer 20

Heart failure = the heart is unable to pump blood at a rate that the body requires.

Left heart failure = restlessness, tiredness, fatigue, shortness of breath, wheezing

Right heart failure = increase in peripheral venous pressure, oedema in legs, enlarged liver/spleen