Chp 19

Question 1

Types of Murmurs

Answer 1

Innocent/functional/normal
- no treatment needed
Organic/abnormal
- caused by a pathologic abnormality in the heart

Question 2

Are congenital heart defects the common heart problem in children?

Answer 2

Yes

Question 3

Examples of L to R Shunts

Answer 3

ASD (atrial septal defect)
VSD (ventricular septal defect))
PDA (patent ductus arteriosus)
AV canal (atrioventricular septal defect)

Question 4

Examples of R to L Sunths

Answer 4

Tetarology of Fallot
Tranposition of the great vessels
Tricuspid atresia
Truncus arteriosus
Hypoplastic left heart syndrome
Ebstein anomaly

Question 5

What is tetralogy of Fallot

Answer 5

VSD
pulmonic stenosis
Aorta overrides VSD
Hypertrophy of right ventricle

Question 6

Obstruction of Blood flow

Answer 6

pulmonary valve stenosis
aortic stenosis with bicuspid aortiv valve
coarctation of aorta

Question 7

Congentital disorders with cardiac defects

Answer 7

Down
Turner
Noonan
Marfan
Ehler-Danlos
DiGeorge
other 22q11 microdeletion syndromes

Question 8

Signs and symptoms

Answer 8

Dyspnea
syncope
murmur
cyanosis
clubbing of toes or fingers
polycythemia
exercise intolerance

Question 9

Complications

Answer 9

Congestive heart failure
pulmonary edema
growth retardation/failure to thrive
infective endocarditis
brain abscess

Question 10

Surgeries to correct defects

Answer 10

Simple shunts - patch “hole in heart”
Valvotomy - relief of the obstruction
Tetralogy of Fallot 0 Blalock-Taussig shunt vs complete repair
Transposition of the great arteries - Arterial switch operation
Single ventricle defect - Glenn shunt, fontan operation

Question 11

Medications for right or left ventricular failure, pulmonary edema

Answer 11

Diuretics
ACE inhibitors

Question 12

Medical consultation is recommended to detemine specific diagnosis, fuctional status and risk of ____________

Answer 12

infective endocarditis

Question 13

What is Rheumatic Fever

Answer 13

delayed, non suppurative sequela with diffuse inflammation to upper respiratory infection with group A beta hemolytic strep infection

results in an autoimmune reaction arising from corss reactivity beween tissues and antibodies produced by the host response to the strep infection

Question 14

Prevalence of Rheumatic Fever

Answer 14

ages 5-15
high altitudes, temperature zones, substandard living conditions

Question 15

Symptoms of Rheumatic fever

Answer 15

Arthritis
carditis
chorea
erythema marginatum
subcutaneous nodules

Question 16

Complications of Rheumatic fever

Answer 16

Inflammatory reaction in the heart
larger joints
skin
lungs

Question 17

Medical management of Rheumatic fever

Answer 17

Benzathine Penicillin G
Salicylates
Codeine

Question 18

What is Rhematic Heart Disease

Answer 18

Carditis results from rheumatic fever

Question 19

Prevalence of Rheumatic HD

Answer 19

Uncommon in developed countries, but pockets in the US exist

Question 20

Symptoms and signs of Rheumatic Disease

Answer 20

Murmur
exertional dyspnea
congestive heart failure

Question 21

Complications of Rhuematic Heart Disease

Answer 21

Scar tissue and deformity of the affected valves (mitral or aortic)
heart failure
pericarditis

Question 22

Medical management of Rheumatic heart disease

Answer 22

Asymptomatic disease requires no treatment other than prevention of recurrent attacts of rheumatic fever

Question 23

Dental managemet of Rheumatic heart dsease

Answer 23

Consult PCP
Possible infective endocarditis prophylaxis

Question 24

What is a cardiac arrhythmia

Answer 24

Variation in the normal cardiac rhythm (disturbance in rhythm, rate or conduction)

Question 25

Sings and symptoms or cardiac arrhythmia

Answer 25

Bradycardia
tachycardia
irregular hert beat
palpitation
dizziness
syncope
Malignany ventricular arrhythmia may lead to ventricular fibrillation and cardiac arrest
other arrhythmias are typically well tolerated

Question 26

Low risk cardiac arrythmia

Answer 26

asymptomatic
no medications
not hemodynamically significant

Question 27

Mod risk cardia arrythmia

Answer 27

potential for symptoms
mild hemodynamic compromise
E.g. - SVT

Question 28

High risk cardiac arrythmia

Answer 28

potential for cardiac collapse
E.g - malignant ventricular arrhythmia, long QT syndrome, Brugada syndrome, presence of pacemaker or internal defribrillator

Question 29

Medical management of cardiac arrythmia

Answer 29

Medication: beta blockers, calcium channel blockers, misc agents, digoxin
Radiofrequency ablation
Pacemakers - for complete heart block
Internal defibrillator - for malignant ventricular arrythmia

Question 30

Dental management of cardia arrythmia

Answer 30

Medical consult
minimize stress
reduce anxiety for pre medication, nitrous, or sedation
short morning appointments
minimize use of epinephrine
avoid GA
avoid electrical equipment that may interfere with pacemaker

Question 31

Oral complications from anti-arrhymics

Answer 31

Ulceration
xerostomia
petechia

Question 32

What is hypertension

Answer 32

Systolic pressure exceeds the 95th precentile for gender age and height after 3 readings in a non stressful situation

Question 33

Essential hypertension

Answer 33

more common in adolescents than children and infants

Question 34

Secondary hypertension

Answer 34

Underlying disorder - renal, cardiac, endocrine
Medication: oral contraceptive, others

Question 35

Symptoms of hypertension include

Answer 35

usually asymptomatic
headache
visual blurriness
changes in mental state
dizziness

Question 36

Medical management of hypertension

Answer 36

Medical history
drug therapy with diuretics, beta blockers, ace inhibitors, calcium channel blockers, vasodilators,

Question 37

Dental management of hypertension

Answer 37

record blood pressure
proceed with treatment with controlled to mild hypertension
if moderate hypertension schedule short morning appt and plans to reduce anxiety
postpone elective treatment if severe hypertension