Chronic cardiovascular disease

Question 1

what does the heart do?

Answer 1

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

Question 2

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

Answer 2

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

Question 3

what is atherosclerosis?

Answer 3

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

Question 4

what condions does atherosclerosis cause?

Answer 4

myocardial infarction
angina
stroke/TIA
peripheral arterial disease
mesenteric ischaemia

Question 5

what is required for the formation of atherosclerosis?

4

Answer 5

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

Question 6

what are the modifiable risk factors for cardiovascular disease?

8

Answer 6

hypertension
obesity
diabetes
lipids
smoking
alcohol
stress
poor sleep

Question 7

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

4

Answer 7

old age
male
family history
ethnicity

Question 8

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

Answer 8

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

Question 9

what are the complications of hypertension?

6

Answer 9

atherosclerosis
chronic kidney disease
heart failure
stroke
retinopathy
vascular dementia

Question 10

what are the modifiable risk factors for hypertention?

8

Answer 10

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

Question 11

what are the non-modifiable risk factors for hypertension?

5

Answer 11

age
gender
ethnicity
genetic factors
familiy history

Question 12

how do you manage hypertension?

2(7,5)

Answer 12

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

Question 13

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

Answer 13

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

Question 14

what is angina?

Answer 14

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

Question 15

what are the two types of angina?

Answer 15

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

Question 16

how do you manage coronary heart disease?

4

Answer 16

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)

Question 17

what is PCI - percutaneous coronary intervention?

Answer 17

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

Question 18

what is CABG - coronary artery bypass graft surgery?

Answer 18

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

Question 19

what is heart failure and the two different types?

Answer 19

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 into systemic circulation (results in fluid in the legs and abdomen - peripheral oedema)

Question 20

what are some of the causes of heart failure?

5

Answer 20

hypertension
coronary artery disease
valvular heart disease
arrythmias
congenital heart disease

Question 21

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

6

Answer 21

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

Question 22

how do you manage heart failure?

4

Answer 22

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

Question 23

what is an arrythmia?

Answer 23

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

Question 24

what is atrial fibrillation?

Answer 24

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

Question 25

how do you manage atrial fibrillation? | 2

Answer 25

anticoagulant medicaitons - DOACs rate-controlling medication - bisoprolol

Question 26

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

Answer 26

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

Question 27

what is valvular disease? what does it do to the valves? what does it do to the heart? | 4

Answer 27

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

Question 28

what are the causes of valvular disease? | 5

Answer 28

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

Question 29

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

Answer 29

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

Question 30

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

Answer 30

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

Question 31

describe valve disease following MI

Answer 31

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

Question 32

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

Answer 32

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

Question 33

what diseases can lead to a valve replacement? | 4

Answer 33

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

Question 34

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

Answer 34

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

Question 35

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

Answer 35

**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**

Question 36

what can infective endocarditis cause? | 3

Answer 36

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

Question 37

how do you manage infective endocarditis? how do you prevent it? | 2,4

Answer 37

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

Question 38

what are the predisposing factors of infective endocarditis? | 5

Answer 38

* acquired valvular heart disease with stenosis * hypertrophic cardiomyopathy * previous infective endocarditis * structural congenital heart disease * valve replacement

Question 39

give examples of some predisposing dental procedures that can cause

Answer 39

Question 40

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

Answer 40

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

Question 41

what are the dental implications of chronic cardiovascular disease?

Answer 41