Cardiovascular Disease Flashcards
More than – million Americans (about 25% of the population) are estimated to have some form of CVD with about – million having coronary heart disease
70
13
Although on the decline, the mortality rate is –% (pre Covid)
33%
what is the leading cause of death in the US after age 65?
cardiovascular disease
cardiovascular disease is responsible for – million new or recurrent heart attacks annually, of which –% are fatal
1.2
40
risk factors for heart disease (4)
heredity
sex
race
age
Heredity
30% of heart disease risk stems from genetic factors, much more than was previously understood
People with parents or siblings affected by coronary atherosclerotic heart disease are at risk for development of the disease at a younger age than that typical for those
without such a history
Sex
Men develop heart disease 10 years earlier on average than women, especially with low testosterone. However, women catch up postmenopausal
Race
African Americans are more at risk. In part due to being at risk for hypertension. Hispanics living in America are about 25% less likely to die of heart disease than non-Hispanic whites. May be due to lower smoking rate in general
Age
Majority of people who die of coronary disease are 65 or older
risk factors for heart disease are factors that can’t be
changed
general warning signs and symptoms (8)
Extreme fatigue Constant dizziness or lightheadedness A fast heat rate (more than 100 bpm) A new, irregular heartbeat Chest pain or discomfort during activity that goes away with rest Difficulty breathing during regular activities and rest Nausea and cold sweats Edema (ankles)
Edema (ankles) may be a sign of
venous insufficiency
If you press on a swollen area and an indentation or pit remains, it’s called
pitting edema
types of fluid retention with edema (2)
mild
severe (pitting)
major risk factors for CV disease (7)
Smoking Diabetes Cholesterol Hypertension Obesity Sleep apnea Family hx.
single most modifiable risk
smoking
minor risk factors for CV disease (3)
excessive alcohol use
stress
age
stenosis
narrow or obstruction
where does stenosis usually occur?
aortic valve
stenosis can be caused by (3)
rheumatic fever
calcification of valve
congenital abnormalities
breathing in dyspnea (3)
difficult
labored
uncomfortable
dyspnea is usually due to (2)
COPD
asthma
orthopnea
difficulty breathing when lying down
causes of orthopnea (4)
heart failure
COPD
panic disorder
sleep apnea
Coronary artery disease (CAD)
decreased or blocked blood flow to the heart due to plaque (cholesterol) build up
CAD is a leading cause of (2) in patients with diabetes
morbidity and mortality
If you have diabetes, you are — as likely to have heart disease or a stroke than someone who doesn’t have diabetes and at a younger age
twice
The longer you have diabetes, the more likely you are to have
heart disease
ABCs of cardiovascular disease and diabetes
manage your ABCs
A: get a regular A1c test aim to stay in your target range
B: try to keep your BP WNR
C: manage your cholesterol levels
s: stop smoking
atherosclerosis
progressive clogging of the arteries
where does atherosclerosis occur? (2)
large to medium muscular arteries
large elastic arteries
atherosclerosis can lead to (3)
thrombosis (blood clot)
infarction
ischemic lesions
ischemic lesions can be of (3)
brain
heart
extremities
major risk factor of atherosclerosis (2)
Elevation in serum lipid levels
Increased BP
in general, — blood pressure is more strongly related to the incidence of CVD than is — blood pressure, especially in older adults
systolic
diastolic
SBP rises throughout life, and DBP tends to level off or decrease after the age of
50
what can chest pain cause? (3)
angina pectoris
hyperventilation
acute MI
most common cause of chest pain
angina pectoris
lease common cause of chest pain
acute MI
angina pectoris is usually
brief, resulting from temporary ischemia of the myocardium
hyperventilation is
common
acute MI pain is usually
prolonged
most important symptom of angina pectoris
chest pain
angina pectoris is usually described as a sensation of (3)
aching, heavy, squeezing pressure
angina pectoris is tightness in the
midchest region
Area of discomfort with angina pectoris often is reported to be the size of a fist and may radiate into the (4)
left or right arm, neck or mandible
Pain of angina pectoris is of brief duration, lasting - to - minutes if the provoking stimulus is stopped
5-15
cause of angina pectoris
Blood supply to the cardiac muscle is insufficient for oxygen demand (atherosclerosis or coronary artery spasm)
angina pectoris can be observed in absence of (3)
coronary obstruction-anemia, hypoxemia, or profound hypotension
Angina episodes may be precipitated by (3)
stress, anxiety, or physical activity
someone with angina pectoris can have hypertension due to the (2) but vitals are usually normal
pain, and possible anxiety
Angina is defined in terms of its pattern of
symptom stability
STABLE Angina
is pain that is predictable, reproducible, unchanging, and consistent over time. Pain typically is precipitated by physical effort such as walking or climbing stairs but can occur with eating or stress
stable angina may be confused for
indigestion
Pain of stable angina is relieved by (3)
cessation of the precipitating activity, by rest, or the use of nitroglycerin
Most patients with chronic stable angina have underlying
Coronary Artery Disease. The plaques tends to be slow growing and relatively stable.
UNSTABLE ANGINA
Is defined as new-onset pain, increasing in frequency, and/or intensity, and is precipitated by less effort than before. It can also occur at rest
The pain of unstable angina is not readily relieved by
nitroglycerin
The key feature of unstable angina is the (2)
changing character (increasing intensity, frequency) or pattern of pain
Patients with stable angina have a relatively good
prognosis
Patients with unstable angina have a poorer prognosis and often experience an – – within a short time
acute MI
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nitroglycerin study example (5)
STUDY: 380 patients with documented Coronary AD and angina
At least one risk factor was present in 96% of the patients
Only 46% of the patients had a prescription for SNG
Of those with a prescription for SNG, only 65% were informed by the physician on the proper use
Of those who were routinely carrying SNG, 37% had an expired product
nitroglycerin exerts action in
2-4 min
nitroglycerin duration of action is
30 min
side effects of nitroglycerin (4)
pounding in head
flushing
tachycardia
possible hypotension
angina pectoris treatment steps (5)
Stress reduction protocol Avoid excess vasoconstrictors Oxygen as necessary Nitroglycerine tabs Small bottle (plastic or metal, often keychain case, 1-2 tabs sublingual) 4444 if doesn’t go away
with angina pectoris treatment, place patient in what position?
sitting-up or semi-sitting position with head elevated
why do we put them in this position?
Ensure open airway and breathing is adequate
what do we check next?
vitals
Dispense/administer nitroglycerin either tablet or spray sublingually. Repeat every
5 minutes up to 3 doses in a 15-minute time period
Always check BP between each dose. If the systolic BP drops below 100mm/Hg do not give an additional dose of Nitroglycerin. Do not want to create profound (2)
hypotension and reflex tachycardia
what life threatening outcome can angina pectoris lead to
hypotensive shock
If pain is not relieved, (2)
give one aspirin 325 mg and call 911
Viagra was originally developed by Pfizer for the treatment of (2)
hypertension and angina pectoris
Women and men report different symptoms of MI, with fewer women experiencing — — but more often experiencing (2)
chest pain
fatigue and dyspnea
Patients who have experienced an acute MI should be
hospitalized or receive emergency treatment as soon as possible
Basic management goal is to (2)
minimize the size of the infarction and prevent death from lethal arrhythmias
Early administration of aspirin is recommended, with 160-325 mg being chewed and swallowed to (2)
decrease platelet aggregation and limit thrombus formation
signs and symptoms of MI
Development of chest pain
Cyanotic, pale, or ashen appearance
Death of cardiac muscle due to inadequate blood oxygen supply
The condition may progress to cardiac arrest
With unresponsive patients-initiate CPR, including use of automated external defibrillator (AED)
Development of chest pain, sometimes manifested as a (3) feeling, that is more severe than with angina and lasting longer than 15 minutes; and is not relieved by nitroglycerin in a conscious patient
crushing, squeezing or heavy
Cyanotic, pale, or ashen appearance
weakness, cold sweat, nausea, vomiting, air hunger and sense of ‘impending death’ irregular pulse
acute MI is a
heart attack
acute MI is a lack of
O2 to tissues
lack of O2 to tissues causes
ischemia (damage)
what occurs after 4-6 hours of actor MI?
permanent damage (necrosis)
plaque ruptures can result in
thrombus (blood clot) formation
Dental treatment of Post-Myocardial Infarction
< 8 weeks out:
> 8 weeks out:
< 8 weeks out, No elective Dental Treatment
> 8 weeks out, Elective Dental Treatment possible, need to: Obtain a Medical Consultation-what is the patient’s cardiac status? Is the patient’s cardiac condition stable? What is the patient’s ejection fraction? Does the patient have any degree of heart failure?
what should INR be for patients on anticoagulants with MI
2-3
stress reduction protocol (5)
Short appointments Early morning appts Limit vasoconstrictors Profound anesthesia Explain everything
Limit vasoconstrictors
Generally, less than
2 carpules
Explain everything
“tell, show, do”
CHF
congestive heart failure
CHF is usually called
heart failure
CHF usually occurs at what age??
> 65
CHF results from any structural or functional cardiac disorder that impairs the ability of the
ventricle to fill with or eject blood
complex of symptoms with CHF (2)
not an actual diagnosis
end stage of many CV diseases
number 1 cause of CHF
coronary heart disease
number 2 cause of CHF
cardiomyopathy
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other causes of CHF (5)
Hypertension Valvular insufficiency Myocardial infarction Infective endocarditis Pulmonary embolism
CHF signs and symptoms (7)
Fatigue and weakness Ankle swelling (edema) Clubbing of the digits Syncope (fainting) Angina Breathing difficulties Increased urination at night
CHF respiration symptoms (4)
Dyspnea
Orthopnea
Sleep apnea
“How many pillows do you sleep on?”
“How many pillows do you sleep on?” (2)
Under the head
>2 pillows = caution
INR
international normalization ratio
CHF risk (3)
cardiac arrest
stroke
MI
DILATED cardiomyopathy is caused by (2)
CAD or poorly controlled hypertension
SYSTOLIC cardiomyopathy reduced ejection fractions and is the most common type of
heart failure.
can dilated and systolic be used interchangeably?
yes
causes of cardiomyopathy (4)
unknown/idopathic (50%)
alcohol abuse
hereditary
viral infections
