Cardiovascular (Liu) Flashcards by Matthew Stringham

What blood pressure reading requires deferring
dental treatment and directing patient to their primary
care provider or the ER?

180/110

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What is the cause of 90% of hypertension diagnoses?

Unknown causes, usually primary hypertension.

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When get a high blood pressure reading, what should you ask the patient?

What are your symptoms? Are you in any pain?

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What dental instruments are contraindicated in patient with a pacemaker?

Electrosurgery
Ultrasonic scalers
Battery operated curing lights

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If patient has atrial fibrillation, what does this mean is going on in the heart?

Atrium not pumping correctly. Some blood inside will

be static. Static blood clots

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What is the expected treatment/medical prescription for atrial fibrillation?

MD will prescribe anticoagulant (Coumadin or Warfarin) to avoid clotting in atrium

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If patient is taking an anticoagulant, what must their INR be for minor oral surgery (single tooth extraction)?

Therapeutic range (2.0-3.5). Consider packing foam 
and suturing after EXT.

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What is the ideal time span for an INR?

The day of surgery

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What type of procedure can you perform if the INR is in the 2.0-3.5 range?

Simple EXT, e.g. perio involved tooth. NOT a boney

impacted #16

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How many carpules of local anesthesia with 1:200,000 epi can be administered in a patient with hypertension?

2 carpules

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What is the term for stenosis of the arteries that brings nutrients and oxygen to the heart itself so it can function?

Coronary artery disease

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What is the term for and ultrasound of the heart to look at heart structure and check ejection fraction?

Echocardiogram

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What is the term for an electrical picture of the heart?

Electrocardiogram (ECG/EKG)

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What is the term for a balloon blown up in the vein to break up an
occlusion?

Angioplasty

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What is the term for metal mesh holding a blood vessel open?

Stent

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What is the term for the procedure whereby you bypass a part of a coronary artery that is blocked?

Bypass surgery

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What are 3 questions to ask to assess patients risk for the

procedure you will perform?

Severity of the patient’s disease
Type of procedure planned
How is patient right now

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What risk level is basic dental operative considered?

Low cardio risk

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Gauging a patient’s ability to perform normalphysical activity is gauging their what?

Functional capacity

The Metabolic Equivalents of Tasks (METs), which isna method to determine a person’s functional capacity, quantifies what?

The body’s use of oxygen

A MET is equivalent to what with respect to oxygen?

MET is a unit of oxygen consumption

1 MET = 3.5 mL of O2/kg of body wt/minute at rest

A patient is at risk of a perioperative cardiovascular event if they do not meet what MET level?

4-MET

What are some types of CV disease?

HTN 
Arrhythmia 
Ischemic heart disease/coronary artery disease
Heart failure 
Infective endocarditis 
Cardiomyopathy 
Inflammatory heart disease

What are the limits for stage 1 hypertension?

140-159 sys or 90-99 dias

What are the limits of stage 2 hypertenion?

>160 sys or >100 dias

If the patient has had a balloon angioplasty, how many days after the angioplasty must you wait before you perform head and neck surgery with aspirin?

More than 14 days

If the patient has a bare-metal stent placed, how many days after the placement should you wait before you perform head and neck surgery with aspirin?

More than 30-45 days

If the patient has had a drug-eluting stent placed, how long should you wait after the placement before you perform a head and neck surgery on that patient with aspiring?

More than 365 days

Can EPI be given to a pt with mild/stable angina or a past history or MI?

Yes, no more than 2 carpules (0.036 mg) at a time

If a patient has unstable angina or a recent MI, can they be given EPI?

Yes, nor more than 2 carpules (0.036mg ) at a time.Consider prophylactic nitroglycerin before procedure

What are some heart conditions that require prophylaxis prior to dental procedures?

1. Prosthetic cardiac valve 2. Previous infective endocarditis 3. Congenital Heart Disease - unrepaired cyanotic - repaired cyanotic but w/in 6 months of repair -repaired cyanotic, but w/residual defects 4. Transplant that develops valvulopathy

If a patient requiring antibiotic prophylaxis for | cardiac reasons has bleeding from trauma to the lips or oral mucosa, is antibiotic prophylaxis indicated?

When is antibiotic prophylaxis indicated for dentistry?

All dental procedures involving manipulation of gingival tissue or periapical region of teeth or perforation of the oral mucosa

Does perforation of the oral mucosa include routine anesthetic injections through noninfected tissue?

In patients where antibiotic prophylaxis is indicated, how long before the procedure should the antibiotics be given?

30-60 minutes before the procedure

What is the prophylactic dosage for orally administered amoxicillin?

2 g adult | 50 mg/kg child

What is the prophylactic dosage for IV or IM Ampicillin (unable to take oral amoxicillin)?

2 g adult | 50 mg/kg child

What is the prophylactic dosage for IV or IM Cefazolin or Ceftriaxone (unable to takeoral amoxicillin)?

1 g adult | 50 mg/kg child

If the patient is allergic to penicillin or ampicillin, what are alternatives for prophylaxis?

Cephalexin Clindamycin Azithromycin Clarithromycin

What is the regimen for prophylaxis with cephalexin (penicillin or ampicillin allergy)?

2g adult | 50mg/kg child

What is the regimen for prophylaxis for clindamycin (penicillin or ampicillin allergy)?

600 mg adult | 20 mg/kg child

What is the prophylactic regimen for Azithromycin/Clarithromycin (penicillin orampicillin allergy)?

500 mg adult | 15 mg/kg child

If the patient is allergic to penicillin or ampicillin and unable totake Cephalexin, Clindamycine, Azithromycin, Clarithromycin orally, what is the alternative for prophylaxis?

Cefazolin or Ceftriaxone IV/IM | Clindamycin phosphate IV/IM

What is the prophylactic regimen for Cefazolin/Ceftriaxone IV or IM for prophylaxis (penicillin or ampicllin allergy and unable oral)?

1 g adult | 50 mg/kg child

What is the prophylactic regimen for Clindamycin phosphate IV or IM for prophylaxis (penicillin or ampicillin allergy and unable oral)?

600 mg adult 20mg/kg child

What is an acronym for treating Acute Coronary Syndrome that incorporates IV?

``` A-airway B-breathing C-circulation O-oxygen M-monitor I- IV ```

What is an acronymn for treating Acute Coronary Syndrome that incorporates aspirin and nitroglycerine?

M-Morphine O-Oxygen N-Nitroglycerin A-aspirin