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Oral Medicine and Diagnosis > Caring for the Cardiac Pt > Flashcards

Caring for the Cardiac Pt Flashcards

1
Q

what is the most common cause of premature death in the world

A

cardiovascular disease

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2
Q

what are the types of CVD disease

A
  • HTN
  • atherosclerosis
  • CAD
  • CHF
  • arrhythmias
  • bacterial endocarditis
  • angina pectoris
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3
Q

pts frequently have _____ CVD

A

more than one

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4
Q

CVDs are:

A

interrelated

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5
Q

CAD leads to:

A

infarction

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6
Q

what is bacterial endocarditis characterized by

A
  • infection
  • inflammation
  • scarring
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7
Q

what is CHF associated with

A

-dilated ventricles with weak muscles
- thickened myocardium

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8
Q

what is valvular heart disease characterized by

A

-stenotic and not capable of full closure for blood circulation
-leads to CHF

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9
Q

what are the conditions that are CVD risk factors

A
  • high BP
  • high cholesterol
  • diabetes
  • rheumatic fever
  • more than 1 CVD
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10
Q

why is high BP a risk factor

A

stiffens vessels which reduces blood flow

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11
Q

why is high cholesterol a risk factor

A

a risk for stroke, kidney disease, and dementia

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12
Q

why is diabetes a risk factor

A

unstable glucose levels affect healthy myocardium function, angiopathy

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13
Q

what are the behavioral risk factors

A
  • unhealthy diet: carbs, caffeine, fats, Na+
  • physical inactivity: poor circulation
  • obesity- excess weight stresses heart function, HTN, CAD
  • too much alcohol- increases BP, arrythmias
  • tobacco use; increases HR, BP, CAD
  • stress
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14
Q

what are the family hx risk factors

A
  • genetics
  • becoming older
  • ethnicity
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15
Q

what are the contributary anatomic abnormalities in CVD

A
  • hypertrophy
  • dilation
  • valves
  • regurgitation
  • stenosis
  • vascular
  • heart structure
  • rhythm
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16
Q

what are the physiologic changes in CVD

A
  • arrhythmias
  • heart failure
  • ischemia
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17
Q

what are the signs of CVD

A
  • elevated BP
  • irregular or abnormal HR
  • abnormal respiratory rate
  • shortness of breath upon exertion
  • prolonged bleeding/easy bruising
  • surgical scars
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18
Q

what are the symptoms of CVD

A
  • patient is uncomfortable in supine position
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19
Q

what are the physical activity questions you should ask your patient

A

-do you feel shortness of breath at rest
- are you physically active?
- what kind of activities do you engage in?
- do you feel shortness of breath after exercise
- does it limit the intensity of your physical activity

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20
Q

what are the hypertension history questions you should ask the pt

A
  • how long have you had high BP
  • who manages your BP, primary care or cardiologist?
  • how long have you been on this current antihypertenisve regimen?
  • have there been any recent changes to your BP meds? Why?
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21
Q

what are the HTN monitoring questions you should ask

A
  • what is your usual BP at the doctors office
  • do you check your BP at home
  • what are your usual readings, how high does it get>
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22
Q

what are the management strategies for pt with HTN

A

check BP - 3 readings at 5-10 min intervals- 2 automatic and 1 annual

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23
Q

what are the 2 things that you would do with diagnosed HTN- being treated

A
  • elevated: 120-129/ less than 80: proceed with tx
  • greater than or equal to stage 1: 130-180/greater than 120: med consult -> within BP goal proceed with tx with cardiac measures OR BP goal unmet no dental tx
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24
Q

what is the protocol for undiagnosed HTN

A
  • elevated: proceed with tx but recommend med eval
  • greater than or equal to stage 1: no dental tx until med eval
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25
Q

what BP should pt be referred to emergency room

A

SBP greater than 180 and/or DBP greater than 120

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26
Q

what is normal bp

A
  • systolic: less than 120 AND
  • diastolic: less than 80
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27
Q

what is elevated BP

A
  • systolic: 120-129 AND
  • diastolic: less than 80
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28
Q

what is high blood pressure stage 1

A

-systolic: 130-139 OR
- diastolic: 80-89

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29
Q

what is high blood pressure stage 2

A
  • systolic: 140 or higher OR
  • diastolic: 90 or higher
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30
Q

what is hypertensive crisis

A
  • systolic: higher than 180 and/or
  • diastolic: higher than 120
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31
Q

how many readings do you need to dx HTN

A

greater than or equal to 2 readings on greater than or equal to 2 separate visits

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32
Q

the less the symptoms and the better the control of risk factors then:

A
  • the better a pt manages the stress
  • the less likely the pt will have a life threatening incident during a dental procedure
  • and vice versa
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33
Q

what are the low level interventions

A
  • health/med eval
  • exams
  • prophy
  • radiographs
  • optical oral scans
  • alginate impressions
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34
Q

what are the moderate interventions

A
  • SRP
  • simple restorative procedures: 1-2 teeth
  • simple extractions: 1-2 teeth
  • restorative impressions needing retractions and longer setting times
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35
Q

what are the high risk interventions

A
  • complex restorative procedures on greater than 2 teeth
  • multiple extractinos
  • surgical extractions
  • implant placement
  • full arch impressions
  • dental care under general anesthesia
36
Q

time of procedure correlates to:

A

risk category

37
Q

what is atherosclerosis

A
  • inflammatory disorder with accumulation of lipid plaque within the arterial walls
  • thickened intima (decreased arterial lumen)
  • decreased oxygen
  • decreased blood flow to the myocardium
38
Q

what does athersclerosis lead to

A
  • stenosis
  • angina (stable ischemic disease)
  • MI
  • ischemic stroke (acute ischemic disease)
  • peripheral arterial disease
39
Q

what are the risk factors for atherosclerosis

A
  • male sex
  • age
  • smoking
  • lack of exercise
  • obesity
  • stress
  • DEPLETION
  • FAM HX OF CVD
  • hyperlipidemia - high LDL
  • HTN
  • INSUIN RESISTANCE
  • DM
40
Q

athersclerotic plaques can lead to:

A
  • ischemia
  • thrombosis (vascular blockage) if they rupture
41
Q

what are the steps in atherosclerosis

A
  • chronic endothelial injury: HDL, HTN, smoking, monocysteine, hemodynamic factors, toxins, viruses, immune reactions
  • endothelial dysfunction: increased permeability, leukocyte adhesion, monocyte adhesion, and emigration
  • smooth muscle emigration from media to intima, macrophage activation
  • macrophages and smooth muscle cells engulf lipid
  • smooth muscle proliferation, collagen and other extracellular matrix deposition
42
Q

what are the symptoms of atherosclerosis

A
  • chest pain
  • angina
43
Q

what are the complications of atherosclerosis

A
  • unstable angina
  • MI - necrosis
  • thrombosis
  • embolism
  • aneurysm
44
Q

what does the RAA system do

A

maintains physiologic BP when BP is low

45
Q

what does AT1 do

A
  • smooth muscle cell contraction
  • systemic vasoconstriction
  • increased vascular resistance
  • aldosterone release
  • sodium reabsorption
  • decreased renal medullary blood flow
  • increased BP
46
Q

what does AT2 do

A
  • antiproliferative effects
  • natriuresis
  • vasodilation
  • decreased BP
  • pilocarpine (salagen)
47
Q

what is the RAA system pathway

A
  • angiotensinogen -> renin -> angiotensin I -> ACE -> angiotensin II -> ACE2 -> angiotensin 1-7
48
Q

what causes the release of renin

A
  • decreased sodium delivery
  • decreased renal afferent perfusion pressure
  • increased renal sympathetic activity
  • increased vasodilation
49
Q

what releases angiotensinogen

A

liver

50
Q

what releases renin

A

kidney

51
Q

what releases ACE

A

lung

52
Q

what does Angiotensin II act on

A

adrenal gland and vessels

53
Q

what does aldosterone act on

A

kidney

54
Q

what are the complications of HTN

A
  • CAD
  • heart failure
  • MI
  • stroke
  • Peripheral artery disease
  • retinopathy
  • end stage renal disease
55
Q

BP is determined by:

A

indirect measurement in the upper extremities with a BP cuff and stethoscope

56
Q

cuff should encompass ____ of the circumference of the arm

A

80%

57
Q

center of cuff over:

A

brachial artery

58
Q

cuff too small ->

A

falsely elevated values

59
Q

white coat HTN ->

A

elevates BP by 30mmHg

60
Q

pregnant pts increase systolic BP by:

A

greater than or equal to 10mmHg

61
Q

why is HTN in pregnant pts concerning

A

risk of eclampsia

62
Q

where should the proper arm position be when taking BP

A

horizontal at heart level - mid sternum

63
Q

arm below heart level ->

A

over estimates systolic and diastolic pressures

64
Q

arm above heart level ->

A

under estimates systolic and diastolic pressures

65
Q

what are the HTN goals usually

A

less than 130-149/ 80-90 mmHg

66
Q

no dental care at UMKC if BP is:

A

greater than or equal to 180/110

67
Q

what is classified as a hypertensive urgency

A

180/120

68
Q

what do you do if pt blood pressure is greater than or equal to 180/120

A

urgent referral to see doctor ASAP or if symptoms are present go to ER

69
Q

what are the lifestyle modifications for HTN

A
  • diet: increase fruit intake, decrease sodium, increased potassium
  • physical exercise/weight loss
  • tobacco cessation and alcohol intake reduction
70
Q

what are the SE of ACE inhibitors

A
  • angioedema
  • neutropenia/agranulocytosis
  • taste disturbances
71
Q

what are the SE of sodium channel blockers

A
  • dry mouth
  • gingival overgrowth
  • hypersensitivity reaction syndrome
72
Q

what are the SE of calcium channel blockers

A
  • gingival overgrowth
  • dry mouth
  • taste disturbances
73
Q

what are the SE or diuretics

A

dry mouth

74
Q

what are the SE of alpha adrenergic blockers

A

dry mouth

75
Q

what are the SE of beta adrenergic blockers

A

dry mouth, angioedema

76
Q

what are the oral manifestations of HTN meds

A
  • dry mouth - alpha adrenergics and diuretics
  • burning mouth (ACE)
  • taste changes (Antiadrenergics, ACEi)
  • angioedema (ACEi, ARB)
  • gingival hyperplasia (calcium channel blockers and other 2
  • lichenoid reactions (thiazides, methyldopa, propranolol, labetalol
    -lupus like lesions ( hydralazine)
77
Q

what are the oral manifestations of HTN

A

none - only due to meds

78
Q

what are the dental considerations for the HTN Pt

A
  • serious potential complications of severe uncontrolled HTN:
  • stroke
  • angina
  • arrhythmia
  • MI
79
Q

what may increase Pt BP

A

stress, anxiety, fear

80
Q

what should you consider for pts taking nonselective beta blockers

A

use of vasocontrictors can cause an acute risk in BP

81
Q

pts may be sensitve to sudden position changes causing:

A

orthostatic hypotension

82
Q

whatt are the pre operative considerations for the HTN pt

A
  • reduce stress and anxiety
  • may need oral and/or inhalation sedation
83
Q

what are the intra operative considerations for the HTN pt

A
  • profound anesthesia (most important)
  • limit epi to 2 carpules if taking a selective beta blocker- 2 carp rule
  • dont use Epi gingival retraction cord
84
Q

what are the post operative considerations for the HTN pt

A
  • avoid macrolide ABs with calcium channel blocker: increases CCB levels
  • avoid long term use of NSAIDs ( more than 2 weeks)
  • stage 2, monitor BP during tx if 180/110 stop tx
  • raise pt slowly after tx bc of hypotension
85
Q
A

Oral Medicine and Diagnosis (12 decks)

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