Cardiovascular Pathology Flashcards
What cardiovascular problem is finger clubbing linked to?
Congenital heart defect
What cardiovascular problem is a pale nail bed associated with?
Anaemia
What cardiovascular problem are splinter haemorrhages associated with?
Bacterial endocarditis
What is the cause of gingival hypertrophic?
Nifedipine antihypertensive medication
What is the cause of xanthelasma - yellow plaque around eyes?
Elevated cholesterol
What is the normal range of heart rate?
60-100 bpm
What are the possible causes of chest pain?
Respiratory
Cardiac disease
Trauma
Psychological
What are the differential diagnosis of chest pain?
Unstable angina: pain at rest
Myocardial infarction: pain at rest >15 mins
Aortic dissection: sever sudden pain, asymmetric pulse
Pericarditis: pain worse on inspiration
Pneumothorax: sudden pleuritic pain, SOB
Pulmonary embolism: pleuritic pain, SOB
Oesophageal rupture: pain after vomit, pain swallowing
Da Costas syndrome: left stabbing pain, anxiety
What is the blood pressure threshold for hypertension?
> 140/90 mmHg
What are the two types of hypertension?
Primary: no specific cause, genetic, environmental, African
Secondary: narrowing of aorta, drugs (steroids), pregnancy, renal disease
What are the pathological changes of hypertension?
Arteriolar sclerosis
Left ventricle enlarges
Atheroma formation, arteries narrow - ischaemic HD
Aneurysms
What are the clinical features of hypertension?
Asymptomatic until target organs affected
Dizziness, epistaxis
Predisposes stroke
What is the treatment for hypertension?
Primary: lifestyle modifications
Secondary: treatment of cause
Antihypertensive drugs: vasodilation, low cardiac output ABCD: ACE, beta blocker, ca channel, diuretic
What are the four types of hypertensive patient?
Normotensive
Controlled - be aware, treat as normal
High BP in practice - defer treatment and refer
Malignant - referred urgently to hospital
What is the dental relevance of hypertension?
Stressful environment
Postoperative bleeding
Oral side effects of medication
Do not carry out treatment on >160/10
Breathless laid flat
What are the oral side effects of hypertension drugs?
ACE: lichenoid, loss of taste, burning
Beta: xerostomia, lichenoid
Ca: salivation, gingival hyperplasia
Diuretic: xerostomia, altered taste
What is the most common cause of ischaemic heart disease?
Coronary atheroma (plaques)
What are the pathological effects of IHD?
Atheromatous plaque restricts blood flow
Formation of thrombus
Narrowed lumen
Myocardial infarction
What are the clinical features of IHD?
Angina - crushing chest pain
Radiates to neck, jaw, teeth, left arm
Resolves with rest
What are the two classifications of angina?
Stable - responds to rest and medication
Unstable - gets progressively worse and occur at rest
What is the treatment of IHD?
Lifestyle, underlying abnormalities, surgical stents
Nitrates
Aspirin
GTN spray - use before
Beta blocker
Ca channel
Nicorandil - unstable angina, ulcers
What is the dental relevance of IHD?
Emergency: GTN 0.5mg sublingually, 300 mg chewed aspirin
Presents with tooth ache, jaw pain
What are the oral side effects of angina medication?
Aspirin - bleeding
Beta - mucosal
Ca - gingival hyperplasia
Nicorandil - mucosal, ulcers
When should you consider myocardial infarction?
Crushing chest pain lasting more than 15 mins
What are the signs and symptoms of MI?
SOB
Radiates to neck teeth left arm
Nausea
Sweating, pale
Tachycardia
Manage same as angina
What is a thrombus made up of?
Platelets
RBC
Fibrin
What are the causes of deep vein thrombosis?
Virchows triad:
Stasis of normal blood flow
Damage to blood vessel wall
Composition change of blood
What are the pathological effects of DVT?
Blood clot obstructs venous blood flow
Break off into emboli
What are the clinical features of DVT?
One lower limb
Swelling
Tenderness and pain
Erythema
What is the treatment for DVT?
Anticoagulant - warfarin
Resorbes clot
What is the dental relevance of DVT?
Can lead to pulmonary embolism
Anticoagulant drugs require local haem measures
How much blockage of arteries is considered atheroma/atherosclerosis?
More than 70% lumen occlusion
What are the 3 stages of pathogenesis for an atheroma?
Initiation - influx cholesterol, plaque formation
Progression - oxidised LDL, fatty streaks, monocytes
Destabilisation - sclerosis, fibrous cap, rupture
What are the three common causes of heart failure?
Due to problem with systole or diastole
Hypertension - LV fails
Valvular heart disease
Ischaemic heart disease - lack of blood and O2
What is the pathology following heart failure?
Left ventricle - decreased blood to body, fluid builds up in the lungs
Right ventricle - fluid builds up in periphery of body
Congestive - left failure leads to right and then both
What are the symptoms of heart failure?
Depends on which ventricle
SOB
Weight gain - left
Swelling in ankles, legs, abdomen - right
What is the treatment for heart failure?
Lifestyle, surgical - valves/heart transplant
ACE - decrease cardiac workload
Diuretics - reduce fluid overload
Inotropic - increase contractility
What is the dental relevance of heart failure?
Breathless if laid flat
Keep treatment short
Unstable refer to doctor
What is the cause of congenital heart defect?
Diseases in first trimester
Familial
What is the pathology following congenital heart defect?
Obstructive defects - narrowing of flow
Septal defects - hole in the heart, abnormal flow
Cyanotic defects - less oxygen than normal
Shunts - diverted blood
What are the clinical effects of congenital heart defect?
Cyanosis - blue
Heart failure
Heart murmur
Chest infections
What is the treatment for congenital heart defect?
Surgery
What is the dental relevance of congenital heart disease?
Supine position makes them breathless
What are the 4 requirements for rheumatic fever to occur?
Group A beta haemolytic streptococcal infection
Susceptible host
Pharyngeal site
Persistence of infection
When does rheumatic fever occur?
2-3 weeks after strep sore throat
Cross reacting antibodies attack tissues
Which parts of the heart does rheumatic fever affect?
Connective tissues
Valves - mitral
What are the clinical features of rheumatic fever?
Fever
Poly arthritis
Murmur or endocarditis
Subcutaneous nodules
Chorea
What is the treatment for rheumatic fever?
Bed rest
Analgesia
Treat strep infection
Aspirin
Corticosteroids if carditis
What is the dental relevance of rheumatic fever?
Increased risk of endocarditis after treatment
No more antibiotic prophylaxis
What are 50% of infective endocarditis caused by?
Streptococcus viridans
From dental treatment
What is the pathology causing infective endocarditis?
Damaged/prosthetic heart valves
Congenial heart defect
Mitral valve affected
What are the clinical features of infective endocarditis?
Local valvular damage - narrowing and murmur
Septic emboli
Finger clubbing
Flu, weight loss
What is the treatment of infective endocarditis?
Antibiotic therapy
