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BDS2 BAMS Diseases of Human Systems > Chronic cardiovascular disease > Flashcards

Chronic cardiovascular disease Flashcards

hypertension, coronary heart disease, heart failure, atrial fibrillation, valvular heart disease, infective endocarditis

1
Q

what does the heart do?

A

pumps oxygenated blood to the systemic circulations (left) and deoxygenated blood to pulmonary cirulations (right)

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2
Q

what is the effect on tissues if the blood vessels become narrowed?

A

im paired blood flow to tissues:
* reduced oxygen and nutrient delivery
* reduced waste removal

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3
Q

what is atherosclerosis?

A

deposition of fatty deposits in the artery walls which creates “stiffening” and narrowing in the arteries which results in “stenosis”

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4
Q

what does atherosclerosis result in?

A

myocardial infarction
angina
stroke/TIA
peripheral arterial disease
mesenteric ischaemia

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5
Q

how does plaque form in the blood vessels?

4

A

damage to the vessel wall (e.g. hypertension and smoking)
high lipid content in the blood (LDL cholesterol)
high circulating glucose (diabetes)
immune cells

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6
Q

what are the modifiable risk factors for cardiovascular disease?

8

A

hypertension
obesity
diabetes
lipids
smoking
alcohol
stress
poor sleep

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7
Q

what are the non-modifiable risk factors for cardiovascular disease?

4

A

old age
male
family history
ethnicity

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8
Q

what is hypertension? what determines it? what does it do to the body?

A

high blood pressure
>140/90
causes excess strain on vessels and organs

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9
Q

what are the complications of hypertension?

6

A

atherosclerosis
chronic kidney disease
heart failure
stroke
retinopathy
vascular dementia

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10
Q

what are the modifiable risk factors for hypertention?

8

A

smoking
excess alcohol
high dietary salt intake
obesity
lack of physical exercise
anxiety
emotional stress
caffeine

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11
Q

what are the non-modifiable risk factors for hypertension?

5

A

age
gender
ethnicity
genetic factors
familiy history

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12
Q

how do you manage hypertension?

2(7,5)

A

lifestyle modifications: obesity, dietary modifications, smoking, alcohol, caffein, salt, stress
medications: ACE-inhibitors, angiotensin-2-receptor blockers, beta blockers, calcium channel blockers, diuretics

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13
Q

what is coronary heart disease? and what does it result in?

A

atherosclerosis resulting in hardening and narrowing in the coronary arteries, resulting in angina and myocaridal infarction

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14
Q

what is angina?

A

collection of symptoms due to myocardial ischaemia, classically referred to as central crushing chest pain that can radiate to left arm or jaw

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15
Q

what are the two types of angina?

A

stable angina: only experienced during exertion
unstable angina: experienced at rest

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16
Q

how do you manage coronary heart disease?

4

A

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)

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17
Q

what is PCI - percutaneous coronary intervention?

A

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

18
Q

what is CABG - coronary artery bypass graft surgery?

A

bypass narrowed part of artery
* blood flow through damaged coronary artery is bypassed
* harvest vessel from elsewhere in body (commonly leg)

19
Q

what is heart failure and the two different types?

A

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)

20
Q

what are some of the causes of heart failure?

5

A

hypertension
coronary artery disease
valvular heart disease
arrythmias
congenital heart disease

21
Q

what are some of the symptoms of heart failure? which symptoms relate to dentistry?

6

A

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

22
Q

how do you manage heart failure?

4

A

lifestyle modification
medications - diuretics, beta blokers
cardiac resynchronisation device
surgery - heart transplant

23
Q

what is an arrythmia?

A

abnormal heart rhythm due to interrupted electrical signals that coordinate heart muscle contraction

24
Q

what is atrial fibrillation?

A

disorgansied electrical activity in the atria, resulting in fibrillation (random muscle twitching) and irregular tissue due to uncoordinated heart muscle activity

25
Q

how do you manage atrial fibrillation?

2

A

anticoagulant medicaitons - DOACs
rate-controlling medication - bisoprolol

26
Q

what is a pacemaker? how does it interact with dentistry?

A

maintain cardiac rhythm for other arrythmias by delivering a controlled elecrtical impulse to restore normal activity
* can interact with bipolar diathermy in oral surgery

27
Q

what is valvular disease? what does it do to the valves? what does it do to the heart?

4

A

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

28
Q

what are the causes of valvular disease?

5

A

aging - aortic stenosis
congenital - bicuspid aortic valvue
damage following MI
rheumatic heart disease
inefective endocarditis

29
Q

what is a bicuspid aortic valve? how is it managed?

A

aortic valve has 3 leaflets instead of 2
congenital
managed with medications or surgery

30
Q

what is aortic stenosis? how does it lead to heart failure? how is it managed?

A

narrowing and stiffness of the aortic valve occurs with aging - calcification
LV works harder as increased pressure, eventually fails = heart failure
management - valve replacement

31
Q

describe valve disease following MI

A

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

32
Q

what is rheumatic heart disease? how do you manage it?

A

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

33
Q

what diseases can lead to a valve replacement?

4

A

severe aortic stenosis
rheumatic heart disease
papillary muscle rupture
congenital valvular disease

34
Q

what are the differences between metallic and bioprosthetic valves in a replacement?

A

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

35
Q

what is infective endocarditis? how can you get it in dentistry? how is it diagnosed?

A

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

36
Q

what can infective endocarditis cause?

3

A

impaired heart valve function - heart failure
focus of infection - sepsis
source of emboli - stroke

37
Q

how do you manage infective endocarditis? how do you prevent it?

2,4

A

managed with 4-6 weeks of IV antibiotics and surgery
prevention:
* regular check ups
* tooth brushing instruction
* dietary advice
* high fluoride toothpaste

38
Q

what are the predisposing factors of infective endocarditis?

5

A
  • acquired valvular heart disease with stenosis
  • hypertrophic cardiomyopathy
  • previous infective endocarditis
  • structural congenital heart disease
  • valve replacement
39
Q

give examples of some predisposing dental procedures that can cause

A
40
Q

what is antibiotic prophylaxis? what is given in dentistry? what happens if the patient has a penicillin allergy?

A

antibiotics given to prevent a disease rather than to treat it
* amoxicillin 3g oral sachet 60 mins before
* 600mg clindamycin capsules

41
Q

what are the dental implications of chronic cardiovascular disease?

A

BDS2 BAMS Diseases of Human Systems (12 decks)

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