Chronic CV Diseases

Question 1

What is the aetiology of hypertension?

Answer 1

No causes (essential hypertension), rare causes (renal artery stenosis, endocrine tumours)

Question 2

What are the signs and symptoms of hypertension?

Answer 2

usually none, may get TIAs, may get headaches

Question 3

What are the investigations for hypertension?

Answer 3

urinalysis, serum biochemistry, serum lipids, ECG, renal ultrasound/angiography, hormone estimations

Question 4

What are the treatment options for hypertension?

Answer 4

modify risk factors, single daily drug dose (thiazide diuretic, ACE inhibitor, beta blocker, calcium channel antagonist)

Question 5

What are the different types of heart failure and what are their aetiology?

Answer 5

high output failure = anaemia, thyrotoxicosis
low output failure = cardiac defect e.g. MI, heart valve disease
left/right heart failure, congestive heart failure

Question 6

What are the signs and symptoms for heart failure?

Answer 6

left heart failure = lung and systolic effects (dyspnoea, tachycardia, low BP, low vol. pulse)
right heart failure = venous pressure elevated (swollen ankles, ascites, rasied JVP, enlarged tender liver, poor GI absorption)

Question 7

What are the treatment options for heart failure?

Answer 7

acute (emergency hosptial management - oxygen, frusemide, morphine)
chronic (community based - treat any underlying cause, improve myocardial function, reduce compensation effects)
drugs (diuretics, ACE inhibitors, nitrates, inotropes)

Question 8

Describe the ASA classifications.

Answer 8

ASA I = normal healthy patient
ASA II = patient with mild systemic disease e.g. smoker, obesity, well controlled hypertension/diabetes
ASA III = patient with severe systemic disease, not incapacitating e.g. poorly controlled hypertension, diabetes, distant history of MI/TIA/cardiac stent
ASA IV = patient with severe systemic disease that is a constant threat to life e.g. recent MI/TIA/cardiac stent
ASA V = a patient who is not expected to survive without an operation e.g. ruptured abdominal aneurysm
ASA VI = declared brain dead

Question 9

How would undiagnosed atrial fibrillation be recognised when feeling a patients pulse?

Answer 9

irregular and random strength - fast, fluttering pulse

Question 10

What are the differences between a metal prosthetic valve and a porcine valve?

Answer 10

metal prosthetic valves require anticoagulant use as blood clots around these
porcine valves do not

Question 11

What does asystole look like on an ECG?

Answer 11

flat line

Question 12

How does ventricular fibrillation look like on an ECG?

Answer 12

extremely irregular rhythm, absent P wave, no cardiac output

treat with defibrillation

Question 13

What two heart valves are most commonly replaced?

Answer 13

Mitral and aortic valves

Question 14

What causes heart valve disease?

Answer 14

congenital abnormality, myocardial infarction, rheumatic fever (does not always do this), dilatation of the aortic root

Question 15

What are the implications for dental care of a patient who has a history of prosthetic valve replacement?

Answer 15

anticoagulant use, INR must be between 2 and 3 (normal=1), extraction must be packed with pressure and/or sutures, risk of endocarditis

Question 16

Which patient groups are at risk of infective endocarditis from an oral bacteraemia?

Answer 16

previous endocarditis, valve replacement, structural congenital heart disease, hypertrophic cardiomyopathy

Question 17

Describe what each segment represents on a normal sinus rhythm ECG.

Answer 17

P wave = atrial depolarisation
QRS wave = ventricular depolarisation
T wave = ventricular repolarisation

Question 18

Describe angina.

Answer 18

Reversible ischaemia of the heart muscle

Caused by narrowing of one or more coronary arteries

Question 19

What are classical angina symptoms and signs?

Answer 19

No pain at rest
Pain with certain level of exertion - worse with cold weather/emotion
Pain relieved at rest
Central crushing chest pain - may radiate to arm, back, jaw
Often no signs
Occasionally hyperdynamic circulation (anaemia, hyperthyroidism, hypovolaemia)

Question 20

What are the investigations for angina?

Answer 20

ECG - resting and exercise
Eliminate other disease
Angiography
Echocardiography
Isotope studies (function assessment)

Question 21

What are the treatment options for angina?

Answer 21

Reduce oxygen demands of heart (reduce afterload, reduce preload)
Increase oxygen delivery to tissues
Dilate blocked/narrowed vessels - angioplasty
Bypass blocked/narrowed vessels - CABG (coronary artery bypass grafting)
Modify risk factors
Reduce MI risk - aspirin
Hypertension - diuretics, Ca channel antagonists, ACE inhibitors, B blockers
Reduce preload/dilate vessels - nitrates
Emergency - GTN spray

Question 22

How is a MI usually caused?

Answer 22

Atheroma in vessels - ulcerated plaque with platelet aggregates, thrombosis on surface
Thrombosis can enlarge rapidly to block vessel
Plaque surface/platelets detach - travel and block vessels, no blood flow to that area -> infarction

Question 23

What is hypertension?

Answer 23

Increased BP systolic >140mmHg, diastolic >90mmHg

Question 23

What are pacemakers used for and what are their dental implications?

Answer 23

used to treat bradyarrhythmias, maintain minimum heart rate, sensitive to electromagnetic fields (avoid use of ultrasonic scalers and electrosurgery units)

Question 24

What are the signs and symptoms of a myocardial infarction?

Answer 24

Pain, nausea, sweaty, ‘going to die’, silent MI (no symptoms or misleading symptoms eg heartburn)

Question 25

What are the investigations for MI?

Answer 25

ECG

Cardiac enzyme levels

Question 26

What are the treatment options for MI?

Answer 26

Hospital, analgesia, aspirin, reassurance, basic life support of required, thrombolysis if indicated, acute angioplasty and stenting if available
Prevent next MI - risk modification, aspirin, B blocker, ACE inhibitor
Treat complications - heart failure, arrhythmias, psychological stress