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BDS2 BASICS > Cardiovascular Medicine > Flashcards

Cardiovascular Medicine Flashcards

1
Q

Risk factors of CV disease?

A
  • irreversible, age sex family history
  • reversible, smoking obesity diet exercise
  • reversible (medical), hypertension hyperlipidaemia diabetes
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2
Q

Approach to prevention for CV disease?

A
  1. lifestyle changes
  2. control total cholesterol (statin treatment)
  3. control hypertension (reduce BP to target of <140/85)
  4. anti platelet drugs - aspirin
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3
Q

relation between dental team and cardiac prevention?

A
  • opportunity for general health education and promotion of good OH
  • diet and lifestyle and offer advice (smoking cessation)
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4
Q

(drugs used in the cardiovascular system) drugs which prevent further disease

A

= anti platelet drugs
= lipid lowering drugs
= anti=arrhythmics
= anticoagulants
= diuretics - furosemide
= ace - inhibitors

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5
Q

(drugs used in the CV system) drugs which reduce symptoms of current disease

A
  • diuretics
  • anti-arrhythmics
  • nitrates
  • calcium channel blockers
  • ace -inhibitors
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6
Q

Name 3 anti-platelet drugs?

A

= aspirin
= clopidogrel
= dipyridamole

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7
Q

How does aspirin work?

A

=inhibits platelet aggregation

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8
Q

Why are anti-platelet drugs used in combination?

A

to increase the effect

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9
Q

What do anti-platelet drugs do?

A

= significantly reduce chance of a heart attack or stroke

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10
Q

relation between anti-platelet drug and dental extractions

A

prolong the bleeding time following dental extraction

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11
Q

Name 5 oral anticoagulants?

A

= warfarin
= rivaroxiban
= apixaban
= dabigatran
= edoxaban

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12
Q

describe warfarin ?

A

= coumarin based anticoagulant
= inhibits synthesis of vit K dependant clotting factors
- 2,7,9,10 - slow 2 days
- protein C & S - quick
= initial hyper-coagulation
- anticoagulation takes 2-3 days
- often HEPARIN used concurrently initially

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13
Q

How is warfarin monitored?

A

INR test- aim for 2-4
prothrombin time

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14
Q

With regards to dental treatment, if the INR is out-with 2-4 what should you do?

A
  • refer for medical advice
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15
Q

with regards to dental treatment if IRN is within 2-4 range ?

A

no alteration needed for dental care

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16
Q

What injection should you avoid if a patient taking warfarin ?

A

ID block

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17
Q

Name 4 NOACS?

A

= apixiban - twice
= dabigatran - twice
= rivaroxiban - once
= edoxaban - once

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18
Q

why is there no anticoagulant test used for NOACs?

A

bioavailability predictable

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19
Q

When is best time to undertake an extraction for a patient taking NOACs?

A

just before dose is due (maximum chance for blood clot to form)

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20
Q

Other drugs preventing CV disease?

A
  • statins
  • beta-adrenergic blockers
  • diauretics
  • calcium channel blockers
  • ACE inhibitors
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21
Q

What is a statin?

A

Lipid lowering drugs

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22
Q

How do statins work?

A

= Inhibit cholesterol synthesis in the liver

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23
Q

What can statins interact with?

A

= omit statin when prescribing anti-fungal treatment (fluconazole)

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24
Q

Examples of statins

A

= simvastatin
= atorvastatin

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25
Q

Examples of B blockers

A

= atenolol
= propranolol

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26
Q

What do B-blockers do?

A

= stop arrhythmias leading to cardiac arrest
= reduced heart muscle excitability

27
Q

What are diuretics and what are some examples?

A

= antihypertensive and for heart failure
= thiazide diuretics (bendroflumethiazide) and loop diuretics (frusemide)

28
Q

2 examples of nitrates and their use?

A

= glyceryl trinitrate (GTN) - short acting- emergency management of angina pectoris
= isosorbide mononitrate - long acting - prevention of angina pectoris

29
Q

How do nitrates work?

A

= dilate veins
= dilate resistance arteries
= dilate colateral coronary artery supply

30
Q

What are calcium channel blockers used for?

A

= hypertension treatment
= migraine treatment

31
Q

With regards to dentistry, what can calcium channel blockers lead to?

A

gingival hyperplasia - dependant of good OH

32
Q

Examples of ACE inhibitors (-pril)

A

= ramapril
= lisinopril
= enalapril

33
Q

How do ACE inhibitors work?

A

= inhibit conversion of angiotensin I to angiotensin II

34
Q

What do ACE inhibitors stand for?

A

= angiotensin converting enzyme inhibitors

35
Q

What do ace inhibitors do?

A

= reduce blood pressure
= reduce excess salt and water retention

36
Q

Oral reaction of ACE inhibitors

A

= angio-oedema
= lichenoid reaction

37
Q

Pathology revision of acute coronary syndromes- what are the 2 processes

A
  • blood vessel narrowing
  • blood vessel occlusion
38
Q

What happens in blood vessel narrowing?

A
  • inadequate oxygen delivery for tissue needs
  • cramp in affected tissue/muscle
  • no residual deficit at first
39
Q

What happens in blood vessel occlusion?

A

= no oxygen delivery - tissue death
= more severe pain
= loss of function of tissue

40
Q

ACS possibilities: stable angina

A

increased demand in setting of a stable atherosclerotic plaque (vessel unable to dilate enough to allow adequate blood flow0

41
Q

ACS possibilities: unstable angina

A

the plaque ruptures and a thrombus forms around ruptured plaque - partial occlusion of vessel

42
Q

ACS possibilities: NSTEMI

A

= plaque rupture and thrombus forms and causes partial occlusion of vessel- causes injury and infarct- rise in troponins

43
Q

ACS possibilities: STEMI

A

= complete occlusion of blood vessel lumen, transmural injury and infarct to myocardium - ECG changes and rise is troponins

44
Q

Biomarker of ACS diagnosis

A

troponin

45
Q

What is angina pectoris? (def, claaical, stable, what do all describe?)

A

= reversible ischaemia of heart muscle
= ‘classical’ angina worse with exercise no biomarkers
= ‘ unstable’ angina symptoms at rest no biomarkers
=all describe central crushing chest pain - radiation to arm, back, jaw possible

46
Q

Angina- investigations

A

= ECG- resting and exercise
= eliminate other disease- thyroid, anaemia and valve
= echocardiography
= angiography

47
Q

Angina- treatment

A

= reduce oxygen demands of the heart - reduce afterload and preload - correct mechanical issues
= increase oxygen delivery to the tissues - dilate blocked/narrowed vessels - bypass blocked/ narrowed vessels (Coronary Artery Bypass Grafting (CABG))

48
Q

Non-drug therapy of angina

A
  • explanation of illness
  • modify risk factors
    = smoking
    =graded exercise programme
    = diet
49
Q

Drug therapy for patients with angina

A

= reduce MI risk- Aspirin
= hypertension- diuretics, ace inhibitors, b blockers
= reduce heart filling pressure - nitrates
= emergency treatment - GTN spray

50
Q

Surgical therapy for angina patient

A

= CABG Coronary artery bypass grafting
= angioplasty and stenting (risk of vessel rupture)

51
Q

What is peripheral vascular disease?

A

= angina of the tissues
= claudication pain on limb on exercise
= managed in same was as angina

52
Q

What can happen as a result of peripheral vascular disease?

A

= limitation of function
= poor wound healing
= can lead to necrosis and gangrene
= aggravated by CV risk factors

53
Q

How can ischaemia lead to infarction?

A

= atheroma in vessels
= thrombosis can enlarge rapidly to block vessel
= plaque surface/ platelets detach

54
Q

What is the strategy for infarction?

A

= reduce tissue loss from necrosis (open blood flow to ischaemic tissue)
=prevent further episode = RF management and aspirin

55
Q

Symptoms and signs of MI?

A

= pain nausea pale sweaty
= going to die
= silent MI’s

56
Q

How can MI be diagnosed?

A

= history
= ECG findings STEMI NSEMI
= Biomarkers (troponin mainly low)

57
Q

MI treatment?

A

=PRIMARY CARE analgesia aspirin reassurance
BLS
=hospital treatment - up to 3 hours from onset of symptoms - Primary PCI
= prevent recurrence

58
Q

What is the best option for delayed admission?

A

Thombolysis (6hrs after symptoms)

59
Q

How does angioplasty and stent work?

A

= catheter inserted through artery
= moved to site of blockage under x-ray control
= balloon inflated to open blockage
= mental stent clicks rigid to hold vessel open and allow blood flow

60
Q

Complications of MI

A

= death
=post MI arrhythmias
= heart failure
= ventricular hypofunction and mural thrombosis
= DVT and pulmonary emolism

61
Q

How to prevent next MI?

A

= risk modification and aspirin
= B blocker
= ace inhibitor

62
Q

How to treat complications of ..???

A

= heart failure
= arrhythmias
= psychological distress

63
Q

What is the primary prevention of CV disease?

A

= smoking cessation, diet and exercise
= encourage fruit and veg, fewer processed

64
Q

What is atherosclerosis?

A

thickening or hardening of the arteries caused by a build-up of plaque in the inner lining of an artery
- medicated with statins

BDS2 BASICS (8 decks)

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