Cardiovascular disease

Question 1

What is Rheumatic Fever

Answer 1

Acute inflammatory disease which affects joints and heart

Question 2

What is Rheumatic Fever preceded by and can follow with

Answer 2

Preceded by streptococcal sore throat (2-6 weeks prior)
Can follow with polyarthritis
Heart valves become damaged and become vulnerable to endocarditis

Question 3

4 requirements for Rheumatic Fever to occur

Answer 3

1. Group A B-haemolytic streptococcal infection
2. Susceptible host
3. Pharyngeal site
4. Persistence of infection

Question 4

What is diagnosis of Rheumatic Fever based on and what catergories

Answer 4

Modified Jones criteria

Minor and Major categories

Question 5

Patients with a history of rheumatic fever are more like to develop which following an invasive dental procedure

Answer 5

More likely to develop endocarditis

Question 6

What use to be required for patients with history of Rheumatic fever prior to invasive dental treatment but is NOT required anymore

Answer 6

Antibiotic prophylaxis (refer to current BNF guidelines)
To PREVENT infection from occuring

Question 7

What is Infective endocarditis

Answer 7

Infection of the endocardium and heart valves
Most commonly blood-borne bacterial infection
Chronic condition
Mostly affected by patients who have had Rheumatic Fever

Question 8

Dental relevance of Infective Endocarditis

Answer 8

• 50% due to streptococcus viridans (an oral commensal)
• 10% are thought to follow dental treatment
• Patients with previous heart diseases are at risk developing it

Question 9

How does heart failure occur…

What is this due to…

Answer 9

When pumping efficiency of the heart is decreased

Due to either contraction (systole) or relaxation (diastole)

Question 10

What are the 3 common causes of heart failure

Answer 10

1. Hypertension
2. Valvular heart disease
3. Ischaemic heat disease

Question 11

Clinical features of heart failure

Answer 11

• shortness or breath
• swelling ankles
• fatigue + weakness
• palpitations, chest pain
• waking up suddenly unable to breathe

Question 12

Treatment of heart failure

Answer 12

Lifestyle choices: exercise, non-smoking, low-salt diet and weight loss

Question 13

Dental relevance of heart failure

Answer 13

• very common
• dental treatments may provoke symptoms and patients can become breathless if laid flat in the chair
• stable patients can be treated within dental practice (MI dentistry/short treatment time/minimum stress)

Question 14

What are Congenital Heart Defects

Answer 14

CHDs are structural, functional or positional defects of the heart that are present at birth for 1% of population but can manifest at any time.
Most CHDs either obstruct BF to the heart or it flows in an abnormal way

Question 15

Dental relevance of Congenital Heart Defects

Answer 15

• Common within population - 1%
• May require antibiotic prophylaxis before high-risk dental treatment (as increase chance of developing endocarditis)
• Liaise with patients cardiologist/doctor before treatment

Question 16

What is Deep vein thrombosis

Answer 16

DVT is due to formation of a blood clot in the deep veins of the lower limb.

Question 17

Clinical features of deep vein thrombosis

Answer 17

1. Usually 1 lower limb
2. Swelling
3. Tenderness + pain
4. Erythema (reddening of overlying skin)

Question 18

Dental relevance of Deep vein thrombosis

Answer 18

• May lead to pulmonary embolism (blocked vessel which can be life threatening if not treated quickly)
• Patients are often anti-coagulated with warfarin and require special care before invasive dental procedures are carried out (haematology)