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Clinical Dental Hygiene II > Chapter 67 Cardiovascular Disease > Flashcards

Chapter 67 Cardiovascular Disease Flashcards

1
Q

What are the manifestations of ischemic heart disease?

A

Angina pectoris
Myocardial infarction
Congestive heart failure

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2
Q

What is Angina pectoris?

A

Chest pain (most common symptom of coronary atherosclerotic heart disease)

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3
Q

Where is Angina pectoris?

A

Middle of the chest and can radiate to the arms and neck or even the mandible

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4
Q

How long does Angina pectoris usually last?

A

1-5 minutes

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5
Q

What are the precipitating factors of stable Angina pectoris?

A

Exertion or exercise, emotion, or a heavy meal

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6
Q

What are the precipitating factors of unstable Angina pectoris?

A

No exertion or exercise. It can occur when the patient is at rest and intensity can vary

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7
Q

What is the treatment for Angina pectoris?

A

A vasodilator, usually nitroglycerin, placed sublingually

And BLS with supplemental oxygen

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8
Q

What is myocardial infarction?

A

The most extreme symptom of ischemic heart disease that results from a sudden reduction of coronary blood flow

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9
Q

What are other names for myocardial infarction?

A

Heart attack, coronary occlusion, and coronary thrombosis

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10
Q

What is the most common artery associated with MI?

A

The anterior descending branch of the left coronary artery

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11
Q

What’s the cause of MI?

A

Can be a thrombosis that blocks artery already narrowed by atherosclerosis. The blockage created an area of infarction which leads to necrosis of the area

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12
Q

Symptoms of MI

A

Pain (may start under sternum, with indigestion, or in mid to upper sternum) that can last for hours and feels like a pressing or crushing heavy sensation

Cold sweats, weakness, faintness, shortness of breath, nausea, vomiting

Blood pressure can drop

Women do not have the same symptoms as men!

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13
Q

Does nitroglycerin help MI?

A

NO

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14
Q

Onset of pain for MI

A

Sudden onset that can happen during sleep or exercise

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15
Q

Management during MI attack

A

Terminate treatment
Sit pt up for comfortable breathing
Give nitroglycerin and reassure pt
Get medical assistance
When nitroglycerin does not reduce pain prepare for BLS
Call emt
Use medical emergency report and record vital signs
Apply basic life support measures and transport to hospital

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16
Q

What is heart failure?

A

When there is an abnormal cardiac function tay is responsible for failure of the heart to pump blood at necessary rate to meet the oxygen needs of the body

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17
Q

Considered an end stage heart condition and results from many forms of cvd’s and can be related to a number of other systemic conditions

A

Heart failure

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18
Q

What are examples of diseases that contribute to heart failure?

A 
Coronary heart disease
Hypertension 
Diabetes
Arrhythmias
Congenital heart disease
Thyroid disorders
Alcohol or drug use such as cocaine
HIV/AIDS
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19
Q

What do the clinical manifestations of heart failure coincide with?

A

The parts of the heart involved

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20
Q

Symptoms of heart failure

A

Usually different depending on which side of the heart is affected.
General effects are extreme weakness, fatigue, fear, and anxiety

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21
Q

What are the signs of left heart failure?

A 
Weakness
Fatigue
Dyspnea
Shortness of breath when lying supine and relieves when sitting up 
Cough or expectoration 
Nocturia (urinate frequently at night) 
Pallor. Sweating cold skin 
Diastolic BP increases 
Heart rate rapid
Anxiety, fear
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22
Q

Symptoms of Right heart failure

A

Weakness, fatigue
Swelling of feet/ankles can progress to thighs and abdomen in advanced stages
Cold hands and feet
Clubbing fingers
Cyanosis of mucous membranes and nail beds
Prominent jugular veins
Congestion with edema in various organs:enlarged spleen and liver. GI distress with nausea and vomiting. Central nervous system involvement with headache and irritability
Anxiety and fear

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23
Q

What are the treatments of heart failure during chronic stages?

A

Drug therapy
Dietary control
And limitation of activity

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24
Q

What should people limit in the dietary control of heart failure?

A

Sodium intake and fluid intake

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25
Q

What is the emergency care for heart failure and acute pulmonary edema?

A 
Position pt upright for comfortable breathing 
Call EMS 
Administer oxygen
Monitor vitals
Reassure pt
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26
Q

Surgical treatment of heart failure

A

Coronary dilation and coronary bypass

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27
Q

What are the types of coronary dilation?

A

Percutaneous transluminal coronary angioplasty and coronary stent

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28
Q

What is percutaneous transluminal coronary angioplasty?

A

Widely used to stretch the coronary blood vessel
A ballon widens the narrowed lumen
An atherectomy may be used to remove atheromatous plaque from the vessel lining

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29
Q

What is a coronary stent?

A

Placed to maintain the open vessel lumen. They are made with metal and become covered with endothelium.
The stent provides a semi-rigid scaffolding within the lumen, which helps prevent narrowing of the lumen

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30
Q

What is the coronary bypass?

A

Coronary artery bypass grafting (CABG)

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31
Q

What is the CABG?

A

Primarily for pts with significant obstruction

Purpose is to “jump pass” over arteries that have been narrowed with atherosclerosis

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32
Q

What are the beneficial effects of CABG?

A

Relief from angina, less work on the heart, and an increase of oxygen and blood supple to the heart muscle

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33
Q

What is the natural pacemaker?

A

The center where the normal heartbeat is initiated and is the sinoatrial node located in the right atrium. From that node impulses are set along the muscle walls to stimulate and regulate the contractions of the ventricles which pulp blood throughout the body

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34
Q

When is a pacemaker indicated?

A

When the natural pacemaker cells are not able to maintain a reliable rhythm, or when the impulses are interrupted because of heart block, cardiac arrest, various arrhythmias, or other disease conditions

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35
Q

What is a cardiac pacemaker?

A

An electronic stimulator used to send a specified electrical current to the heart to control or maintain a minimum heart rate

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36
Q

What are the parts of the pacemaker?

A

Has electrodes inserted transvenously to the endocardium and the electrodes are connected to the power source containing a lithium battery. The pulse generator is implanted under the skin in the thorax or upper abdomen

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37
Q

What is the implantable cardioverter defibrillator?

A

A device that is surgically placed in the chest or abdomen to treat cardiac arrhythmias

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38
Q

What are the parts of the implantable cardioverter defibrillator?

A

Wires with electrodes on the ends bat connect to the heart chambers

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39
Q

Are the EMIS produced from ultrasonic scalers significant enough to disrupt the function of pacemakers and ICD’s?

A

NO

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40
Q

What kind of therapy is used in the treatment of many cvds to prevent embolus and thrombus formation (clotting)

A

Anticoagulant therapy

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41
Q

What are the drugs most commonly used to prevent or delay blood coagulation?

A

Heparin and Coumarin derivatives

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42
Q

What is a test of the coagulation phase of blood clotting used to monitor therapy with anticoagulants?

A

INR (international normalized ratio)

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43
Q

Local hemostatic measures for pts on anticoagulant therapy

A

Instrumentation can be performed on most pts without complication provided precautions are taken to minimize tissue trauma and control bleeding and not to dismiss the other until the bleeding has stopped

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44
Q

How to control bleeding with someone on anticoagulant therapy

A

Pressure: with sponges or cotton pellets packed interdentally

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45
Q

Post procedural instructions for someone on anticoagulant therapy

A

Closely observe pts for 6-8 hours after procedure
Pt is advised to avoid vigorous brushing and rinsing on treated area for several hours or until next day
Extraoral icepacks may help
Use of a soft diet
Moderation of physical activity
Emphasize the maintenance of gingival health to prevent future bleeding problems

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46
Q

Cardiac surgery presurgical

A

Pt is brought to a state of optimum oral health with all sources of infection removed
All other dental procedures are completed
Pt needs info about the importance of OH in eliminating a potential source of infective endocarditis

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47
Q

Cardiac surgery postsurgical

A

Continuing care appointments
Prophylactic antibiotic
Immunosuppressive therapy

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48
Q

Side effect of cyclosporine

A

Gingival enlargement

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49
Q

Anatomical classification of patients with cardiovascular disease

A

Diseases of the heart; pericardium, myocardium, endocardium, heart valves. Diseases of the blood vessels and peripheral circulation

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50
Q

Etiology classification of a patient with cardiovascular disease

A

Congenital anomalies, atherosclerosis, hypertension, infectious agents and immunological mechanisms

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51
Q

Infective endocarditis (IE)

A

Serious disease, prognosis depends on the heart damage and valves involved and duration of the infection and treatment

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52
Q

What microorganisms are responsible for IE?

A

Strep and staph are MOST of the time STREP is most prevalent

53
Q

Majority of IE cases related to oral cavity are caused by what?

A

Ransom bacteremias due to ROUTINE BRUSHING AND FLOSSING

54
Q

Do dental procedures usually cause IE?

A

Few cares of IE result from dental procedures

55
Q

Risk factors for IE:

A
  1. Artificial (prosthetic) heart valves.
  2. Preexisting cardiac abnormalities
  3. IV drug abuse
    * *** if a patient had had IE previously and receives an artificial valve they are MORE susceptible to IE than a patient that has not had IE previously and has an artificial valve
56
Q

Self induced bacteremia

A

From eating, bruxing, chewing gum, interdental aids or any activity that can force bacteria into the susceptible sulcus

57
Q

Bacteremia by Infection at portals of entry

A

Organisms enter the blood through the periodontal and gingival pockets or an open area of infection such as ulcer or ill fitting denture and travel through the bloodstream.

58
Q

Bacteremia caused by trauma to tissues by instrumentation

A

Bacteremias that occur during oral surgery, endo, Perio therapy, scaling, and any therapy that causes bleeding.

59
Q

Disease process of bacteremia

A
  • transient bacteremia initiated
  • bacterial adherence
  • proliferation of bacteria
60
Q

Transient bacteremia initiated

A

Trauma to mucosal surface such as the sulcus during instrumentation releases the bacteria into the bloodstream

61
Q

Bacterial adherence

A

Microorganisms cleave to damaged heart valve, prosthetic valve or other susceptible areas in the heart

62
Q

Proliferation of bacteria

A

Microorganisms multiply to form masses of plasma cells, fibrin and bacteria

63
Q

After the disease process is complete

A

Heart valve becomes inflamed and it’s function weakens. Clips of microorganisms can break off and spread into circulation and complicate things

64
Q

Prevention of bacteremia

A

Pt Hx
Premed
DH care

65
Q

Using Pt history to prevent bacteremia includes

A

Asking questions to be aware of patients who had history of congenital heart defects, cardiac transplant, prosthetic valves, valvular defects, or previous IE

66
Q

Premed to decrease IE (bacteremias)

A

Consult with pt physician if they have a history of heart problems and need premed
Verify pt took premed before tx. Document antibiotic time type and dosage in chart

67
Q

DH care to help prevent IE

A

Make sure pt has good OH. Use pt Ed. have pt brush floss and use oral rinse to decrease bacteria before instrumentation.

68
Q

How does Perio and gingivitis effect incidence of IE

A

The more severe gingivitis or Perio the higher incidence of bacteremia during instrumentation

69
Q

**Normal healthy heart

A

Blood flows one way as each chamber contracts, valves snap shut after each contraction right side of heart caries DEoxigenated bloood to Lund to be reoxigenated. Left side carries oxigenated blood from lungs to cells

70
Q

***When do irregularities develop during pregnancy

A

Develop during the first 9 weeks in utero.

71
Q

***when is fetal heart developed

A

By the 9th week

72
Q

Diagnosing anomalies for CHD (congenital heart diseases)

A

Diagnosing early is important but not all defects need to be treated. If treatment is needed it require surgery

73
Q

Etiology of CHD

A

Genetic, environmental (occurs between 5-8 weeks in utero) or combination
— viral, drugs alcohol and cocaine can Cause CHD

74
Q

Types of defects

A

Ventricular septal defect
Atrial septal defect
Pulmonary stenosis
Patent ductus arteriosis

75
Q

Defects are

A

Openings in septal wall that results in mixing of blood from left and right sides of heart

76
Q

Ventricular and atrial septal defects

A

Mixing of blood between left and right side

77
Q

Other defects

A

Mixing between main arteries and veins (oxygenated and deoxigenated blood)

78
Q

2 if the MORE common defects

A

Ventricular septal defect

Patent Ductus arteriosis

79
Q

Ventricular septal defect

A

Left and right side exchange blood through opening in septum (the dividing wall) oxygenated blood from lung (left side) passes to right ventricle.
—severity of symptoms DIRECTLY related to location and size of defect

80
Q

Patent ductus arteriosis

A

Shunt is open between the 2 great arteries (aorta and pulmonary artery)
This opening usually closes a few weeks after birth. If it doesn’t close blood from aorta can pass back to the lungs.
Heart compensates to try to provide body with oxygenated blood and is overworked

81
Q

Signs and symptoms of CHD

A 
Tire easily 
Dyspnea 
Cyanosis of lips and nail beds 
Poor growth and development 
Heart murmurs and CHF (congestive heart failure)
82
Q

Dental hygiene considerations for a pt with CHD

A

Try to prevent IE

Eliminate oral disease

83
Q

AHA recommendation for pt with CHD

A

Premed because certain defective heart valves are at risk for IE

84
Q

Rheumatic heart disease

A

A complication of the heart following rheumatic fever. A high percent of pts that have had rheumatic fever have heart complications from it

85
Q

Rheumatic fever

A

More frequent in developed countries
Declined in last decades
Not common in USA
usually effects children ages 5-15

86
Q

Onset of rheumatic fever

A

Usually 2-3 weeks after beta-hemolytic group A streptococcal pharyngeal infection. (STREP)

87
Q

Prevention of rheumatic fever

A

Early detection of strep and pharyngeal infections because rheumatic fever following is dependent on how severe the strep was

88
Q

Symptoms of rheumatic fever

A

Low grade fever
Abdominal pain
Shortness of breathe and chest pain related to cardiac issues joint pain with arthritis present in ankles knees wrists and elbows
Joint swelling with warmth and redness
Nose bleeds
Skin rash on trunk and upper parts of arms/legs
Emotional instability
Muscle weakness
uncontrolled jerking of face feet and hands

89
Q

Rheumatic heart disease following rheumatic fever

A

Usually symptoms do not show except valvular deformity

90
Q

Symptoms of rheumatic heart disease

A

Stenosis of valves
Leaky valves (usually aortic and mitral valves)
Heart murmur from scaring of valves and myocardium
Arrhythmias

91
Q

LATE symptoms of rheumatic heart disease

A 
Shortness of breath 
Murmur 
Angina pectoris 
Epistaxis (nose bleed) 
Elevation of diastolic blood pressure 
Enlarged left ventricle 
Increasing signs of congestive cardiac failure
92
Q

AHA recommendation for pt with rheumatic heart disease

A

AHA no longer recommends premed for pt

93
Q

Where is the mortal valve located

A

Between left ventricle and left atrium

94
Q

Mitral valve prolapse

A

Valve becomes misaligned allowing regurgitation.

95
Q

When mitral valve is damaged

A

Closure doesn’t work and allows OXYGENATED blood to back flow “regurgitate”

96
Q

Symptoms of mitral valve prolapse

A

Most pts are asymptomatic
A small amount have palpitations, fatigue, atypical chest pain and systolic murmur.
MORE SEVERE CASES: increase in palpitations and a systolic click and murmur

97
Q

AHA recommendation for mitral valve prolapse

A

No premed

98
Q

**Since AHA doesn’t recommend premed for certain things can we just go ahead and begin tx?

A

NO!! ALWAYS check with pt physician first

99
Q

Hypertension

A

“SILENT KILLER” abnormal elevation of BP

Contributing RISK FACTOR in many vascular diseases

100
Q

**Why is hypertension called silent killer

A

1/3 if people who have it do not have symptoms

101
Q

Hygienist and detecting hypertension

A

Early detection with referral to doctor for tx can save lives

102
Q

Risk factors for hypertension and atherosclrosis are

A

Interrelated

103
Q

Hypertension etiology

A

90% of patients with hypertension are primary or essential

104
Q

Risk factors for hypertension

A 
Tobacco use 
Hereditary 
Overweight
Race 
Salt: in excess
105
Q

Hypertension and race

A

Incidence is higher in African Americans than whites

Illness is more severe and morality weight is higher in younger patients

106
Q

Hypertension effects on men and women

A

Men more effected before 45 and women in older ages

107
Q

Secondary hypertension

A

10% is secondary to other underlying medical conditions.

Both systolic and diastolic are elevated with secondary hypertension

108
Q

Causes of secondary hypertension

A 
Oral contraceptives 
Renal disease 
Endocrine disorders 
Medications
Decongestants 
Steroids
109
Q

Oral contraceptives and hypertension

A

Elevated BP
Occurs more in overweight women and women who have hypertension during pregnancy have a family history and mild kidney disease

110
Q

Endocrine disorders that effect hypertension

A

Hyperthyroidism
Diabetes
Cushing syndrome
Thyroid or parathyroid disease

111
Q

A marked sudden drop in BP

A

Usually an emergency such as severe blood loss, shock myocardial infarction, sepsis

112
Q

Essential hypertension

A

Recognized ONLY by BP readings. Condition may go unrecognized because of lack of clinical symptoms

113
Q

Early symptoms of high BP

A 
Occipital headache 
Dizziness 
Visual disturbances 
weakness
Ringing in ears 
Tingling hands and feet
114
Q

Major sequela of long standing elevation of BP

A

-Brain, eyes heart or kidney may undergo change in function
-hypertensive heart disease
enlarged heart with eventual failure
- cerebral vascular accident (stroke)
Hypertensive renal disease
Ischemic heart disease (hardening of arteries)

115
Q

Malignant hypertension

A

Life threatening
Sudden
Diastolic above 130
Affects about 1% of patients with hypertension

116
Q

Symptoms of malignant hypertension

A 
Any early symptom of high BP 
Blurred vision: loss of sight possible
Severe dyspnea 
Chest pain similar to angina pectoris 
Mental confusion leading to stupor coma or convulsions
117
Q

If pt has malignant hypertension

A

Activate emergency procedures immediately because condition is life threatening is not tested quickly and can result in damage to multiple body symptoms

118
Q

Goals for primary hypertension.

A

To have a level below 80 to lower the risk of serious complications and premature death

119
Q

Goals for secondary hypertension

A

Medical treatment for underlying disease is needed

120
Q

Children 3 years and older should have BP taken how often

A

At least yearly

121
Q

Ischemic heart disease AKA

A

CHD or coronary artery disease

122
Q

Ischemic heart disease

A

A cardiac disability
Acute and chronic
Causes by reduction of blood supply to Heart muscle

123
Q

*****Ischemia

A

Deficiency of blood to supply oxygen resulting in either functional constriction or actual obstruction of a blood vessel

124
Q

***ischemic heart disease

A

Result of imbalance of oxygen to the myocardium resulting in narrowing or blocking of the lumen (opening) of the coronary arteries

125
Q

Main cause of ischemic heart disease

A

Atherosclerosis of the vessel walls which narrows the lumen and obstructs blood flow

126
Q

Atherosclerosis

A

Inflammatory disease of medium and large arteries which deposits (atheromas) thicken the layer of the blood vessel

127
Q

Atheroma

A

Fibro-fatty deposit or plaque containing several lipids; especially cholesterol

128
Q

Risk factors for atherosclerosis

A 
Inflammation 
Elevated lipid in the blood 
Increase in cholesterol intake carbs saturated fat alcohol and calories 
Tobacco use 
Diabetes 
Obesity 
Insufficient exercise 
Increased tension 
Stress
129
Q

**** low grade chronic inflammation in other parts of the body INCLUDING CHRONIC PERIO has A relationship to adverse cardiovascular outcomes

A

Pathogenic microorganisms associated with Perio are associated with atheroma formation in blood.
Many risk factors for Perio are risk factors for atherosclerosis!!

Clinical Dental Hygiene II (14 decks)

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