Chapter 2: Dental Management Of The Patient With Cardiovascular Pathologies Flashcards
Hypertension corresponds to BP of?
140/90 mmHg
80-90% of the patients are asymptomatic, the remaining 10% present initial symptomatology such as:
- occipital headache
- blurred vision
- paraesthesia of lower limbs
- tinnitus
BOPT
Posterior lesions in the heart because of hypertension?
- congestive heart failure
- Ischemic cardiopathy
Posterior lesions in the arteries because of hypertension?
Hemorrhage
Posterior lesions in the kidneys because of hypertension ?
Renal disease
Posterior lesions in the brain because of hypertension?
Stroke, encephalitis, hemorrhages
Posterior lesions in the eyes because of hypertension?
Blindness, hypertension in the eye (glaucoma)
Types of hypertension: primary or essential. What are the predisposing factors
- age
- dietary sodium
- hereditary
- obesity
- stress
90% of the cases
Types of hypertension: secondary. Secondary to a systemic pathology such as?
- renal, endocrine, neurological, eclampsia, and alcoholic disease
10% of the cases
When does eclampsia occur?
20th week: 2nd trimester.
What is the definition of a hypertensive crisis?
Acute decompensation of hypertension.
Greater than 200/120mmHg
3 types of hypertensive crises:
- Hypertensive urgency
- Hypertensive emergency
- Hypertensive pseudo-crisis
Hypertensive urgency:
Absence of acute lesion of target organs, asymptomatic or with mild and non specific symptoms (mild headache, dizziness). Should be gradually corrected in 24-48 hours with oral medication.
Hypertensive emergency:
Acute or progressive lesions of the target organs that may be irreversible and of poor vital prognosis (anticoagulants), requires immediate reduction (less than 1 hour) of the blood pressure with hospital treatment.
Hypertensive pseudo-crisis:
elevation of blood pressure, asymptomatic, and without damage to target organs, secondary to anxiety, pain, hypoxia, that does not require hypotensive treatment but casual treatment.
Non-pharmacological measures for hypertension?
- correct overweight. No fats or cholesterol.
- reduce salt intake.
- daily exercise: 45 mins/day.
- reduce alcohol intake.
- avoid other risk factors (tobacco, diabetes).
- avoid stressful situations.
Pharmacological measures of hypertension?
- diuretics
- beta blockers
- calcium channel blockers
- ACE inhibitors
Diuretics MOA?
Low renal absorption of sodium and calcium
Helps rid ur body of sodium and water
Types of diuretics:
- Thiazides: chlorthalidone (HIGOTRONE).
- Indapamide (TERTENSIF), Hydrochlorothiazide (ESIDREX, HIDROSAUTERIL).
- Felt: Furosemide (SEGURIL).
- K -Spacer : (ALLDACTONE).
Beta blocker MOA?
they antagonise the cardiovascular action of catecholamines.
Block effect of adrenaline/epinephrine
2 types of beta blockers:
Cardio electives
Non cardio selectives
LOLs
Cardio electives:
Atenolol, tenormin
Without interaction or contraindication to dental treatment
Non-cardio selectives:
Propranolol (sumial), may increase the pressure response to adrenaline and cause reflex brachycardia
ACE inhibitors MOA?
Vasodilation
Types of ACE inhibitors:
Captopril, enalapril (renitec), fosinopril, lisinopril
PRILS
Caution with ACE inhibitors and NSAIDs? Alternatives?
Interaction With INDOMETHACIN (NSAID derived from Acetic Acids), resulting in less hypotensive effect. Solution: use IBUPROFEN.
Calcium antagonists MOA?
Depression of myocardial function, slowing of electrical impulses and reduction of coronary and systemic vascular tone.
Types of calcium antagonists?
Dilitiazem, Nicardipine (ADALAT), Nifedipine, Nimodipine, and Verapamil.
PINE
Side effects of diuretics:
Xerostomia, nausea
Side effects of beta blockers:
Xerostomia, depression, sedation, sialadenosis.
Lichenoid reaction
ACEIs side effects?
Lichenoid reactoin, burning mouth, loss of taste.
Calcium antagonists side effects?
Xerostomia, gingival hyperplasia.
Other vasodilators (Hydralazine, nitroprusside, minoxidil) side effects?
Cephalgia, nausea
When does the greatest increase in BP occur?
during extractions, surgeries, and restorative treatments performed ** without anesthesia. **