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BDS 2 Diseases of Human Systems > Cardiovascular Medicine > Flashcards

Cardiovascular Medicine Flashcards

1
Q

Acute Coronary Syndromes definition

A

occurs when theres a sudden reduced blood flow to the heart

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2
Q

How can ACS occur

A

ischaemia [reduced blood flow to the heart, inadequate oxygen tissue delivery], blood vessel occlusion
Unstable angina [ischaemia], which prolonged can lead to infarction - heart attack [STEMI/NSTEMI]

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3
Q

Signs and symptoms of ACS

A

chest pain/discomfort spreading to back/jaw/shoulder/left arm, abdomen pain mistaken for indigestion, shortness of breath, light-headedness, sweating, nausea

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4
Q

Risk factors of ACS

A

old age, family history of heart disease, smoking, diabetes, hypertension, high cholesterol, obesity

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5
Q

Most common cause of ACS

A

thrombus in an artery with atherosclerotic plaque. [unstable angina]
can be coronary artery embolisms [mitral/aortic stenosis, endocarditis]

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6
Q

unstable angina

A

heart doesnt get enough blood flow/oxygen, atherosclerotic plaque, clot on surface but isnt fully occluding the artery. reversible, little cardiac muscle death so normal troponin levels

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7
Q

STEMI

A

ST segment elevation mycordial infarction. full thickness of cardiac muscle wall is affected, atherosclerotic clot which has increased and occluded vessel completely so no blood or oxygen can pass, effects large area of heart
troponin elevated

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8
Q

NSTEMI

A

no ST elevation, interior layer of cardiac muscle death, partial blockness, not full area of heart

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9
Q

Diagnosis of NSTEMI

A

ECG - ST elevation not present
Blood test - test for troponin, elevated levels but not as much as STEMI
partial blockage of coronary artery

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10
Q

Diagnosis of STEMI

A

ECG - elevation of ST segment
Blood test - elevated troponin levels. px needs a test as soon as they arrive at the hospital and one 24 hours later. if it is raised - clear MI
full blockage of coronary artery

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11
Q

Immediate management of ACS

A
  • antiplatelet therapy = 300mg aspirin
  • analgesics
  • anti-thrombin therapy
  • supplemental oxygen
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11
Q

Immediate management of ACS

A
  • antiplatelet therapy = 300mg aspirin
  • analgesics
  • anti-thrombin therapy
  • supplemental oxygen
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12
Q

STEMI management

A

thrombolysis - medications or minimally invasive procedure to break up blood clots and prevent new clots forming
PCI - minimally invasive procedures used to open clogged coronary arteries. by restoring blood flow, tx can improve symptoms of blocked arteries such as chest pain/shortness of breath [percutaneous coronary intervention]

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13
Q

unstable angina management

A

admission to hospital for bed rest with continuous monitoring
low dose aspirin, clopidogrel
angiography within 24-48hrs to see sight of blockage

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14
Q

Drug therapy after confirmed MI

A

anticoagulants - warfarin, slow down process of making clots
beta-blockers - reduce heart rate and blood pressure [bisoprolol]
ace-inhibitors - decrease chemicals which can tighten blood vessels so blood flows smoother and heart can pump more efficiently [lisinoprol]
statins - helps lower LDL cholesterol, lowers risk of hardening and narrowing arteries [simvastatin]

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15
Q

NSTEMI management

A

angiography within 24-48hrs to see site of blockage

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16
Q

Angina

A

chest pain caused by reduced blood flow to the heart muscles

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17
Q

angina signs + symptoms

A

signs - often none, anaemia, hyperthyroidism
symptoms - no pain at rest, pain with exercise, pain relieved by rest

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18
Q

angina investigations

A

ECG done while resting + exercising [shows ischaemia], eliminate other disease, angiography, echocardiography

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19
Q

angina treament

A

reduce oxygen demands of heart [BP, venous filling pressure afterload and preload by medications]
correct mechanical issues [failing heart valves]
increase oxygen delivery to tissues [dilate blocked/narrowed tissues]
CABG [coronary artery bypass grafting]
live within limits, modify risk factors [smoking, obesity]

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20
Q

angina risk factors

A

alcohol use, drug use, stress, smoking, obesity

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21
Q

CABG

A

diverts blood around narrowed or clogged parts of major arteries to improve blood flow and oxygen delivery to the heart
major surgery [mortality risk], limited benefit of 10 years, less effective in smoker

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22
Q

angina drug therapy

A
  • aspirin = reduce MI risk
  • diuretics, calcium channel agonists, ACE inhibitors, beta blockers = hypertension
  • nitrates = reduce heart filling pressure
  • emergency treatment GTN [glyceryl trinitrate] spray/tab = reduces preload, sublingual administration due to FPM
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23
Q

peripheral vascular disease

A

angina of the tissues, usually in lower limbs, pain of exercise but relief on rest
limitation of functions, poor wound healing, tissue necrosis, may lead to amputation
aggravated by CV risk factors, risk of MI

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24
Q

ischaemia

A

blood flow and oxygen is restricted/reduced

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25
Q

infarction

A

death of the tissues due to restriction/reduced oxygen and blood flow [clot or narrowing]

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26
Q

drugs used to prevent further CV disease

A

antiplatelets, lipid lowering, anticoagulants, diuretics, ace-inhibitors

27
Q

drugs used to reduce symptoms of CV disease

A

ace-inhibitors, nitrates, diuretics

28
Q

dental implications of CV disease

A

medications px are on can affect tx, anticoagulants/antiplatelets will reduce clotting and increase bleeding so high risk procedures like extractions need to be considered carefully / planned with GP

29
Q

hypertension

A

raised blood pressure outwith the normal for that population

30
Q

hypertension risk factors

A

age, stress, family history, drugs, obesity

31
Q

causes of hypertension

A

can be hard to define/assess, varies from person-person, usually no triggers found
can be from renal artery stenosis, endocrine tumours, Crohn’s, Conn’s

32
Q

signs/symptoms of hypertension

A

usually none, may get headache, mini MI

33
Q

investigations for hypertension

A

urinalysis, BP, serum lipids, ECG, serum biochemistry

34
Q

treatment of hypertension

A

trying to get back to population level
modify risk factors = smoking, exercise, less salt in diet
single daily drug dose = thiaxide diuretic, beta blocker, calcium channel agonist, ace-inhibitor
monitor over time, tx will change

35
Q

consequences of hypertension

A

stroke risk, ACS risk, heart failure, renal failure, accelerated atherosclerosis

36
Q

heart failure

A

output of the heart is incapable of meeting the demands of the tissues

37
Q

aetiology of heart failure

A

MI, myocarditis, atrial fibrillation, heart block, hypertension, aortic stenosis, drugs [beta blockers, corticosteroids], valve overload

38
Q

left heart failure

A

most common - heart cannot pump blood around the body

39
Q

left heart failure symptoms

A

dyspnoea, tachycardia, low BP, low volume pulse
lung and systolic effects

40
Q

right heart failure

A

cannot pump blood to the lungs, fluid can go to the veins, right ventricle to weak to pump to lungs

41
Q

right heart failure symptoms

A

swollen ankles, ascites, raised JVP, enlarged liver, poor GI absorption, venous pressure elevated

42
Q

congestive heart failure

A

both right and left side heart failure

43
Q

high vs low output failure in heart failure

A

high - demands increased beyond capacity of pump [anaemia, thyrotoxicosis]
low - pump is failing and not strong enough to pump blood around the body [MI, valve disease]

44
Q

treatment of heart failure

A

acutely;
loop diuretics to get rid of fluids
give oxygen and morphine
chronic;
improve myocardial function, treat the cause - hypertension/valve disease/arrhythmia
drug therapy - diuretics [increase salt and water loss], ace-inhibitors [reduce salt/water retention], nitrates [reduce venous filling pressure]
stop negative inotropes - BETA BLOCKERS - they cause heart failure and reduce blood flow

45
Q

causes of valve replacements

A

congenital abnormalities [down syndrome, aortic valve is bicuspid and tricuspid], MI, rheumatic fever, dilation of aortic root
valve has become narrowed [aortic stenosis]
valve has become leaky [aortic regurgitation]

46
Q

which are the most commonly replaced valves

A

aortic and mitral valve
due to stenosis, where valve is narrowed and regurgitation occurs
mitral - back into heart, mitral - back into lungs

47
Q

metal valve replacement

A

longer clinical life, require warfarin coagulation, antibiotic prophylaxis consideration [dental treatment, endocarditis risk], makes a ticking noise

48
Q

tissue valve replacement

A

shorter clinical life, no need for coagulation medication [+ for children], consider antibiotic prophylaxis, silent action, good for elderly as if they have metal and on warfarin and fall = high bleed risk

49
Q

dental implications of valve replacements

A

will be on anticoagulation medications, follow SDCEP guidance, need to know before extraction, cannot stop WARFARIN

50
Q

antibiotic prophylaxis

A

taking antibiotics before tx to decrease the chance of infection

51
Q

what are pacemakers used to treat

A

bradyarrhythmia

52
Q

bradyarrhythmia

A

heart is beating slow, can be through heart block or drug-induced by beta blockers

53
Q

tachyarrhythmia

A

heart is beating too fast

54
Q

how do pacemakers work

A

they keep the heart rate at a minimum level, they do not pace if the heart rate is above a certain level, it is a sensing and pacing circuit
it is placed in the chest wall with wires passing through blood vessels into the ventricle

55
Q

risk of pacemakers

A

electrical field can cause them to shut down - MRI, induction/ultrasonic scaler, electrosurgery units

56
Q

atrial fibrillation

A

irregular and abnormally fast heart rate

57
Q

atrial fibrillation signs + symptoms

A

dizzy, short of breath, tired, heart palpitations, heart pounding/fluttering, pulse faster than normal
atria contracting randomly and heart muscle cannot relax between contractions, reducing efficacy and performance

58
Q

endocarditis

A

inflammation/infection of the endocardium - the inside surface of heart and heart valves

59
Q

what causes endocarditis

A

microbial colonisation, mainly oral steptoccoci

60
Q

how does oral treatment cause endocarditis

A

oral treatment causes a release of bacteria into circulation, this bacteria colonisation arises at the heart as a consequence - dental care is influenced by this risk

61
Q

which dental procedures are an endocarditis risk

A

any which involve the manipulation of the dento-gingival junction and causes a bacteraemia and release a large number of oral streptococci into the blood stream
- extractions, periodontal therapy, gingival surgery, implants, restoration in gingivae or marix used

62
Q

signs + symptoms of endocarditis

A

fever, heart murmur, skin manifestations [patches on skin, lines on nails, spots on palms/soles] headaches, night sweats

63
Q

diagnosis of endocarditis

A

blood cultures over several days to test bacteria, listen to heart, CRP test

64
Q

effects of having endocarditis

A

long-term antibiotics treatment, cardiac valve damage and dysfunction, risk of death, with second diagnosis comes high mortality risk

65
Q

what to do when you have a px with high risk endocarditis

A

identify them, work on prevention of oral disease and excellent oral hygiene, remove sepsis load [deal with carious teeth]

66
Q

procedures with px at high endocarditis risk

A

consider antibiotics prophylaxis - decision made by px physician, communicated to dentist in writing
Montgomery - all effects must be discussed, informed consent, consequences of prophylaxis route or not
avoid risk activity like piercings
3g amoxicillin 1 hour before procedure

BDS 2 Diseases of Human Systems (9 decks)

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