Chronic cardiovascular disease Flashcards
hypertension, coronary heart disease, heart failure, atrial fibrillation, valvular heart disease, infective endocarditis
what does the heart do?
pumps oxygenated blood to the systemic circulations (left) and deoxygenated blood to pulmonary cirulations (right)
what is the effect on tissues if the blood vessels become narrowed?
im paired blood flow to tissues:
* reduced oxygen and nutrient delivery
* reduced waste removal
what is atherosclerosis?
deposition of fatty deposits in the artery walls which creates “stiffening” and narrowing in the arteries which results in “stenosis”
what does atherosclerosis result in?
myocardial infarction
angina
stroke/TIA
peripheral arterial disease
mesenteric ischaemia
how does plaque form in the blood vessels?
4
damage to the vessel wall (e.g. hypertension and smoking)
high lipid content in the blood (LDL cholesterol)
high circulating glucose (diabetes)
immune cells
what are the modifiable risk factors for cardiovascular disease?
8
hypertension
obesity
diabetes
lipids
smoking
alcohol
stress
poor sleep
what are the non-modifiable risk factors for cardiovascular disease?
4
old age
male
family history
ethnicity
what is hypertension? what determines it? what does it do to the body?
high blood pressure
>140/90
causes excess strain on vessels and organs
what are the complications of hypertension?
6
atherosclerosis
chronic kidney disease
heart failure
stroke
retinopathy
vascular dementia
what are the modifiable risk factors for hypertention?
8
smoking
excess alcohol
high dietary salt intake
obesity
lack of physical exercise
anxiety
emotional stress
caffeine
what are the non-modifiable risk factors for hypertension?
5
age
gender
ethnicity
genetic factors
familiy history
how do you manage hypertension?
2(7,5)
lifestyle modifications: obesity, dietary modifications, smoking, alcohol, caffein, salt, stress
medications: ACE-inhibitors, angiotensin-2-receptor blockers, beta blockers, calcium channel blockers, diuretics
what is coronary heart disease? and what does it result in?
atherosclerosis resulting in hardening and narrowing in the coronary arteries, resulting in angina and myocaridal infarction
what is angina?
collection of symptoms due to myocardial ischaemia, classically referred to as central crushing chest pain that can radiate to left arm or jaw
what are the two types of angina?
stable angina: only experienced during exertion
unstable angina: experienced at rest
how do you manage coronary heart disease?
4
lifestyle modification - less alcohol, healthier diet, stop smoking, weight loss
immediate symptom management - GTN spray
long term secondary prevention - manage hypertension, lipids, aspirin
interventional management - percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG)
what is PCI - percutaneous coronary intervention?
widen the narrowed part of the artery
* insert balloon to widen diseased coronary arteries
* insert a stent to maintain artery width
* via femoral or radial artery
what is CABG - coronary artery bypass graft surgery?
bypass narrowed part of artery
* blood flow through damaged coronary artery is bypassed
* harvest vessel from elsewhere in body (commonly leg)
what is heart failure and the two different types?
heart fails to work effectively in its role of pumping blood
* left sided heart failure means congestion of blood from the heart into the pulmonary vein and backing up into the lungs (results in fluid in the lungs - pulmonary oedoma)
* right sided heart failure means congestion of blood from the heart into the vena cava and backing up unto systemic circulation (results in fluid in the legs and abdomen - peripheral oedema)
what are some of the causes of heart failure?
5
hypertension
coronary artery disease
valvular heart disease
arrythmias
congenital heart disease
what are some of the symptoms of heart failure? which symptoms relate to dentistry?
6
shortness of breath (D)
cough (frothy stupum)
orthopneoa - SoB when lying down (D)
paroxysmal nocturnal dyspnoea - suddenly waking up at night with SoB
peripheral oedema - legs, abdomen, sacrum
fatigue
how do you manage heart failure?
4
lifestyle modification
medications - diuretics, beta blokers
cardiac resynchronisation device
surgery - heart transplant
what is an arrythmia?
abnormal heart rhythm due to interrupted electrical signals that coordinate heart muscle contraction
what is atrial fibrillation?
disorgansied electrical activity in the atria, resulting in fibrillation (random muscle twitching) and irregular tissue due to uncoordinated heart muscle activity
how do you manage atrial fibrillation?
2
anticoagulant medicaitons - DOACs
rate-controlling medication - bisoprolol
what is a pacemaker? how does it interact with dentistry?
maintain cardiac rhythm for other arrythmias by delivering a controlled elecrtical impulse to restore normal activity
* can interact with bipolar diathermy in oral surgery
what is valvular disease? what does it do to the valves? what does it do to the heart?
4
disease of the heart valves, affects function
stenosis - stiff valves and doesn’t fully open
regurgitation - valvue doesn’t fully close and is leaky
increased strain on heart
what are the causes of valvular disease?
5
aging - aortic stenosis
congenital - bicuspid aortic valvue
damage following MI
rheumatic heart disease
inefective endocarditis
what is a bicuspid aortic valve? how is it managed?
aortic valve has 3 leaflets instead of 2
congenital
managed with medications or surgery
what is aortic stenosis? how does it lead to heart failure? how is it managed?
narrowing and stiffness of the aortic valve occurs with aging - calcification
LV works harder as increased pressure, eventually fails = heart failure
management - valve replacement
describe valve disease following MI
MI results in death of cardiac muscle
papillary muscles pull chordae tendinae to open tricuspid and mitral valves
infarction of these areas result in valvular dysfunction
what is rheumatic heart disease? how do you manage it?
damage to heart valves by body’s immune system following group A streptococcus throat infection
* bacteria cell wall has M protein antigen
* immune system produced M protein antibody
* cardiac calves have proteins resembling M protein
* immune system attacks valves so fibrosis and vegetation forms
* valves become leaky or stenoic
management - valve replacement
what diseases can lead to a valve replacement?
4
severe aortic stenosis
rheumatic heart disease
papillary muscle rupture
congenital valvular disease
what are the differences between metallic and bioprosthetic valves in a replacement?
bioprosthetic
* less likely to have a blood clot, no anticoagulation meds
* reduced lifespan
* commonly derived from pig tissue
metallic
* longer lifespan
* hihgher risk of blood clot, need warfarin
what is infective endocarditis? how can you get it in dentistry? how is it diagnosed?
infection of the lining of the heart (endocardium), particularly heart valves
* invasive dental procedures introduce bacteria to bloodstream
* bacteria colonises and infects the endocardium and valves
* vegetation forms on valves, become stenoic
diagnosed using Duke’s criteria
what can infective endocarditis cause?
3
impaired heart valve function - heart failure
focus of infection - sepsis
source of emboli - stroke
how do you manage infective endocarditis? how do you prevent it?
2,4
managed with 4-6 weeks of IV antibiotics and surgery
prevention:
* regular check ups
* tooth brushing instruction
* dietary advice
* high fluoride toothpaste
what are the predisposing factors of infective endocarditis?
5
- acquired valvular heart disease with stenosis
- hypertrophic cardiomyopathy
- previous infective endocarditis
- structural congenital heart disease
- valve replacement
give examples of some predisposing dental procedures that can cause
what is antibiotic prophylaxis? what is given in dentistry? what happens if the patient has a penicillin allergy?
antibiotics given to prevent a disease rather than to treat it
* amoxicillin 3g oral sachet 60 mins before
* 600mg clindamycin capsules
what are the dental implications of chronic cardiovascular disease?
