Chronic Cardiovascular Flashcards
Hypertension
What are the known risk factors for hypertension?
- Age
- Race
- Obesity
- Alcohol
- Family history
- Pregnancy
- Stress
- Drugs eg. non steroidal, corticosteroids, oral contraceptivs, sympathomimetics
Hypertension
What is hypertension?
Raised blood pressure
Hypertension
What is an outcome of hypertension?
Accelerated Atheroslcerosis
or renal failure
Hypertension
What can accelerated atherosclerosis contribute to?
3
- MI
- Stroke
- Peripheral Vascular Disease
Hypertension
- What is essential hypertension?
- What is it generally caused by?
- No medical causes found for Hypertension
- genetic changes interacting with the patients environment eg
Hypertension
What are rare causes for hypertension?
- Renal Artery Stenosis
- Endocrine Tumours
Hypertension
What is a TIA?
Transient Ischaemic Attack
- mini stroke
- full neurological return in 24hrs
Heart Failure
Define heart failure
Output of heart is incapable of meeting the demands of the tissues
Heart Failure
What is the difference between High and Low Output Heart Failure?
Give examples
High: demands of the system have increased beyond the capacity of the pump eg. anaemia, thyrotoxicosis
Low: Pump is failing and not strong enough to force liquid around the body eg. cardaic defect such as MI, valve disease
Heart Failure
What are the most common factors that may contribute to LOW output failure?
- Heart muscle disease (MI, diabetes, obesity)
- Pressure overload (hypertension, Aortic stenosis)
- Vol. overload (mitral and aortic incompetence)
Heart Failure
What are less common factros that may contribute to LOW output failure?
- Arrythmias (AF, heart block)
- Drugs eg. Beta blockers, corticosteroids, anticancer drugs
Heart failure
What is ACUTE failure
Left side of heart has a sudden loss of fucntion, fluid accumulated in lungs, patient short of breath
Treatment
1. remove fluid from lungs (diuretic)
2. determine underlying cause and modify
Heart Failure
What are symptoms and signs of Left heart failure?
Lungs and systolic effects: heart not pumping blood out inot circuulation and lungs will accumulate more blood than normal
- dysponea (shortness of breath)
- tachcardia
- low bp
- low vol. pulse
- coughing
Heart Failure
What are symptoms and signs of Right heart failure?
Venous pressure elevated (systemic veins): veins will be filling as the blood is not being taken and pumped around the body
- swollen ankles
- ascites (fluid in abdominal cavity)
- raised JVP (jugular venous pressure)
- tender enlarged liver
- Poor GI absorption
Heart Failure
What are heart failure symptoms?
- shortness of breath
- swelling of feat and legs
- chronic lack of energy
- difficulty sleeping at night due to breathing problems
- swollen/tender abdomen with loss of apetite
- cough with frother sputum
- increased urination at night
- confusion/or impaired memory
Heart Failure
Which drugs may be used for drug therapy for chronic heart failure?
- Diuretics (increase salt and water loss)
- ACE inhibitor (reduce salt/water retention)
- Nitrates (reduce venous filling pressure)
- Inotropes (digoxin - decrease DBP)
Heart Failure
Whic drug type will cause a patients heart failure to become worse?
Beta blockers
Cardiac Arrhythmias
Which arrythmia causes increased heart rate?
Give 2 examples
Tachy Arrhythmias
- AF
- Ventricular Tachycardia
Cardiac Arrhythmias
What are SLOW CA?
Give 2 examples
Brady Arrhythmias
- heart block
- Drug induced (beta blocker, digoxin)
Hypertension
How can blood pressure be measured?
Systolic pressure/Diastolic pressure
Hypertension
What is Systolic Pressure?
The maximum pressure the heart exerts whilst beating
Hypertension
What is diastolic pressure?
The pressure in the arteries between beats
Hypertension
What is the biggest risk to hypertension?
CVA - cerebrokvacular accident (stroke)
- directly related to pressure
Hypertension
Give examples of endocrine tumours that cause hypertension
- Cushing’s syndrome - release of cortisol
- Conn’s syndrome - release of aldosterone
- Pheochromocytoma - release of adrenaline
Hypertension
Which investgations should be carried out if necessary fro an abnormal hypertension patient (eg. young etc)
- Serum (mlood) biochemistry and serum lipid (electrolyte content)
- Urinalysis (electrolyte content)
- ECG
- Occasionally, renal ultrasounds and angiographies
Hypertension
Which drugs can be administered to treat hypertension?
- Diuretic
- Beta blocker
- calcim channel antagonist
- ACE inhibitor
Hypertension
Which drug that may be used to treat hypertension has a side effect of ginigval hyperplasia
Calcium channel blocker
Heart Valve Disease
What is Valve Stenosis and Valve Incompetence?
Valve Stenosis: Narrowing of valve opening
Valve Incompetence: Valve unable to shut properly
Heart Valve Disease
Whihc valves are most likely to have problems?
Those under higher pressure
- mitral valve
- aortic valve
(Left valves)
Heart Valve Disease
What may cause Valve disease?
- Congenital Abnormality
- MI (papillary muscle rupture)
- Rheumatic Fever (causes damage to heart valves)
- Dilatation of the aortic root (aortic valve cusps no longer meet)
Heart Valve Disease
What is the best method to investigate valve disease?
Doppler ultrasound
Heart Valve Disease
What are the two types of prosthetic valves
- Mechanical
- Biological
Heart valve disease
How does a metal prosthetic valve relate to dentistry?
- Patient will be on warfarin (anitcoagulant)
- Will need to modify medication if patient needs an extraction
Heart Valve Disease
- A patient with a prosthetic heart valve has a higher risk of developing which disease?
- What is usually given to prevent this disease?
- Endocarditis
- Antibiotics Prophylaxis
Cardiac Arrhythmias
What are Cardiac Arrhythmias?
Disorders of the heart
Cardiac Arrhythmias
What is the difference between tachyarrhythmias and bradyarrhythmias?
Tachyarrhythmias (FAST)
- atrial fibrilation
- ventricular tachycardia
- heart rate increases
- slow heart by using beta blocker
Bradyarrhythmias (SLOW)
- heart block
- drug induced (digoxin and beta blocker)
Cardiac Arrhythmias
What is atrial tachyarryhthmia?
- Narrow QRS on ECG
- Atrial fibrillation
- Irregular pulse
Cardiac Arrhythmias
What is Ventricular Tachyarrhythmia?
- Broad QRS on ECG
- Can lead to ventricular fibrillation and death
Cardiac Arrhythmias
How does electrical interference of cardiac pacemakers link to dental treatment?
- If a pacemaker detects an abnormal signal the circuit will shut down
- Electrical equipment used in dentistry suucuh as induction scalers can cause strong electromagnetic fields which may interfere with the pacemaker
Congenital Defects
What are the most common congenital heart defects?
- atrial septal defects
- ventricular septal defects
- patent ductus arteriosus
- great vessel malformations
Congenital Heart Disease
What is finger clubbing associated with?
- Cardiac disease
- Lung disease
- IBS
- Liver cirrhosis
Congenital Heart Disease
What is Cyanosis?
increase of deoxygenated haemoglobin in the blood
Endocarditis
