Cardiovascular Disease Flashcards
What are catacholamines
These are neurohormones and high serum concentrations cause high blood pressure high heart rate and symptoms of anxiety
What is the electrical pathway in the heart
SA Node
AV Node
Bundle of hiss
Purkinje fibres
What is the order and meaning of an ECG
TPQRST
P depolarisation of atria
PR segment Tim it take for electrical activity to move between atria and ventricles
QRS complex is ventricular depolarisation
ST segment time between depolarisation and repolorisation of ventricles
Left sided heart failure?
This can lead to pulmonary oedema (A buildup of fluid in the lungs)
Systolic failure
Diastolic failure
When coronary heart disease leads to ineffective ejection of blood
When there is hypertrophy or fibrosis of ventricles reduce the ability to fill
(Both reduce cardiac output)
Breathlessness
No excessive tolerance
Peripheral oedema
What causes heart failure?
Coronary artery disease
Hypertension (chronic leading to hypertrophy)
Faulty heart valves (genetic or disease induced)
Dilated cardiomyopathy (thinking and stretching of ventricles)
Arrhythmia
How do you calculate Cardiac output
 stroke volume times heart rate
What are the lifestyle changes to treat heart Failure?
Regular exercise
Reduce alcohol consumption
Smoking cessation
Immunisations
With what pharmaceuticals is heart failure managed?
Furosemide - loop diuretic reduces swelling from oedema and blood pressure. Causes less water re uptake in kidneys.
ACE - angiotensin converting enzyme inhibitors, (reduces production of angiotensin II) this is the -pril drug class (ramapril, benazepril, captopril, enalapril, finosapril etc) relax veins reducing blood pressure pressure.
ARBs - Angiotensin II receptor antagonist reduce the action of angiotensin II relaxing veins reducing blood pressure. (-sartan drug class, Losartan, azilsartan etc).
Beta Blockers - block hormone action and regulate heart rate, often given after a heart attack to prevent another one. (Drug class - olol, propranolol, bisoprolol etc)
Digoxin - cardiac glycosides prescribed in more severe heart failure.
Spironolactone - used to treat oedema and heart failure
With what pharmaceuticals is acute heart failure managed with?
IV inotropes, these patients are severely unwell and need very close monitoring
What surgery is used to manage heart failure?
Coronary artery bypass graft
Heart valve repairs or replacements
Implantable cardiac defibrillator
What adjuncts do patients with heart failure often take?
Antiplatlet drugs (-el, not exclusive)
Clopidogrel
Ticagrelor
Dipyridamole
Aspirin
Anticoagulant drugs (-arin, -an, not exclusive)
Warfarin
Heparin
Rivaroxaban
Dabigatran
What are some considerations that need to be taken when treating patients with cardiovascular disease?
Antiplatelets and anticoagulants Relating to extractions
Postural problems such as pulmonary oedema were lying flat
Barriers to healthcare such as travelling to appointment
Infective endocarditis risk NICE and SDCEP guidelines
Is antibiotic prophylaxis recommended routinely?
As per NICE guidelines 2016 prophylaxis is not routinely recommended any doubt contact the cardiologist or GP
What is peripheral arterial disease?
This is atherosclerosis mediated disease of the peripheries and largely effects lower limbs and feet and it starts with muscle pain and gangrene extremities
What is Aneurysm?
This is a blood filled dilation of blood vessel caused by disease or weakening of the wall. Abdominal aortic aneurysm is highly deadly these are often asymptomatic until they become very large. 80% of people in community with an abdominal aortic aneurysm will die within an hour
What is carotid artery stenosis?
This may be picked up on an 0PT this is atherosclerosis of the carotid artery this is an important risk factor in stroke and TIA lifestyle changes are required to limit complications such as reducing hypertension and smoking carotid endarterectomy and vascular graft may be required to treat
What is stenosis
Narrowing of blood vessel due to plaque buildup
What is coronary artery disease?
Atherosclerotic plaques developing in the coronary arteries
Risk factors include
Dyslipidaemia
Hypertension
Tobacco smoking
Diabetes
What treatment is suitable for a patient who has had a heart attack in the previous six months?
Only emergency treatment is suitable for a patient who has previously had a heart attack in the last six months. Non-routine treatment can be carried out after this period when the patient is deemed stable enough to treat
When is a patient most likely to develop a cardiac arrhythmia in the dental setting post heart attack?
Add arrhythmia can develop as a response to the adrenaline in the local anaesthetic hence the wait 6 months
 Which part of the CNS controls Rapids adjustments to carduac output?
Arterial baroreceptors
What systems are involved in the long-term adjustments of blood pressure?
It’s multifactorial involves the rennin-angiotensin system, aldosterone and antidiuretic hormone system antihypertensives act on or within all of the systems
What are the pharmacological risk factors for hypertension
Alcohol abuse
Cocaine use
Contraceptive pill
Cyclosporine used for transplant rejection
Over use of NSAIDS
Corticosteroid use
Stress 
What is the ABCD approach for managing heart failure
ACE inhibitors
ARBs
Beta blockers
Calcium channel blockers (-dipine)
Diuretic
What are risks associated with atrial fibrillation (AF)
Leading cause of stroke
Therapeutics prescribed to prevent secondary complications of this
Sarah patient should be taking anticoagulants, if a patient tells you they have a diagnosis of AF and you can’t identify the anticoagulants then you must contact the GP
What is infective endocarditis
This is an infection of the lining surrounding the heart. Bacteria can be found in vegetative plaques. Patients are no greater risk from routine dental procedures than they are from flossing their teeth. This causes reduced heart function and damage
What causes heart murmurs
Fever
Anaemia
Overactive thyroid
Rapid phases of growth
Physical activity or exercise
Pregnancy
What are the symptoms of a heart murmur
Blue nails or lips
Chest pain
Cough doesn’t go away
Dizziness
Swollen liver
Swollen neck veins
Fainting
heavy sweating
