chronic cvs diseases Flashcards
what is hypertension
raised blood pressure
normal BP values
Systolic >120mm Hg
Diastolic > 80mm Hg
symptoms and signs of left heart failure
lungs & systolic effects
fatigue, dyspnoea, FAST HEART RATE (tachycardia), LOW BP, low vol. pulse. oedema in ankles
Pulmonary pressure backlog = accumulates in lungs = hard to breathe = leaked fluid due to increased pressure
Fluid in lungs = cough frothy = sometimes red
Worse at night because when you lie flat fluid is distributed = postural dyspnoea
symptoms and signs of right heart failure
elevated venous pressure and left side failure
swollen ankles, ascites (build up of fluid in a belly), raised JVP, tender enlarged liver, poor GI absorption
kidneys do not filtrate at night; unless fluid overload due to heart failure
management of heart failure
over 55 - diuretics (reduce fluid collection) , calcium channel blockers (stop Ca going into smooth muscle)
older people - beta blockers (slow heart rate) , ace inhibitors (relax blood vessels)
younger than 55 - calcium channel blockers
angiotensin II receptor blockers (real veins and arteries)
often on 2-3 pills – smaller doses – less side effects
how do you diagnose hypertension
BP taken on two different occasions
normal is no greater than 120/80 mmHg
do standing and relaxed values
ECG and electrocardiogram
hypertension causes
corticosteroids
age and gender
kidney disease
aldosterone overproduction – cons syndrome – salt water reabsorption in kidneys
adrenaline overproduction can raise blood pressure
thyroid problems -> increased metabolism and oxygen demand is increased
muscle disease
valve disease – stenosis – narrowing or incompetence (leaky)
heart arrytthmias – irregular beat
most common = fibrosis = less muscle tissue
chronic ischemia = decreased oxygen input for time period
heart failure causes
ischemic heart disease (IHD), hypertension, valve disease, cardiomyopathy, myocarditis (infection), drugs (antifungals, calcium channel blockers, NSAIDS, metformin, cancer drugs, stimulants, antidepressants, tumor necrosis factor inhibitors)
benefits and disadvantages of metal heart valves
lifelong durable
but need anticoagulants
if done on paeds, need to be changed as patient grows
most likely to cause thrombosis
benefits and disadvantages of bio heart valves
do not need lifelong warfarin therapy
but wears out sooner
most likely to be rejected by patient
anticoagulant use for metal valves
the vitamin K antagonist, warfarin, is currently the only oral anticoagulant recommended for patients with aortic and mitral mechanical heart valves.
tell me about pacemakers
used for bradyarrhythmias = SLOW HEART RATE
– maintain minimum heart rate
sensitive to electromagnetic fields – ultrasonic scalers and electrosurgery units. Reset automatically if disturbed
pulp Testers OK - avoid INDUCTION scalers though – these generate strong EM field
after valve replacement in dentistry
need to follow SDCEP anticoagulant guidance for dental care
often need to prescribe antibiotics before big treatment to reduce endocarditis risk
A patient presents with a history of heart failure. Name all of the following symptoms which may relate only to this condition:
orthoopnea (shortness of breath that occurs while lying flat and is relieved by sitting or standing)
ankle oedema
atrial fibrillation
ascites (fluid in the belly)
anticoagulation issues
What are the implications for dental care of a patient who gives a history of a prosthetic valve replacement (2)
Risk of infective endocarditis
Extraction complications if patient is taking anticoagulants
which TWO heart valves are most commonly replaced? (2)
aortic and mitral
how would undiagnosed Atrial Fibrillation be recognised when feeling the patient’s pulse? (2)
irregular beat, higher than 100 beats per minute
Excluding valve replacements, list THREE patient groups at risk of infective endocarditis from an oral bacteraemia (3)
Intracardiac device – pacemaker
Patient with cardiac disease, aortic stenosis, untreated valve disease
Endocarditis history
What oral health advice should be given to a patient at risk of endocarditis? (1)
Regular scaling appointments
Most of the evidence that oral organisms have big role = maintaining oral health
Moving away from antibiotics and motivate patient
what do you understand by the terms
bacteraemia and septicaemia?
bacteraemia means bacteria in the blood stream,
usually at a low level and clinically not of
consequence.
septicaemia is sepsis in the blood
stream and is due to large numbers of organisms in
the blood. Clinical features include rigours, fever and
hypotension.
infective endocarditis may occur as a
complication of dental treatment — what is
infective endocarditis?
inflammation of the endocardium of the heart valves
inflammation of endocardium around congenital defects of the heart
Which organisms commonly cause infective
endocarditis?
STREPTOCOCCI & STAPHYLOCOCCI
Staphylococcus aureus
Streptococcus viridans
Streptococcus faecalis (subacute infective endocarditis) and
Streptococcus pneumoniae
Streptococcus pyogenes (acute infectiveendocarditis); fungi, Chlamydia species and rickettsiae less commonly cause this condition.
which patients are at risk of getting infective endocarditis from dental treatment?
previous history pf endocarditis
those with prosthetic heart valves and surgically constructed systemic or pulmonary shunts or conduits
patients with congenital heart defects
congestive heart failure
>90 yo
what precautions should be taken before
carrying out subgingival scaling under local
anaesthetic in a patient who has had previous
endocarditis if they are allergic to penicillin?
preoperative chlorhexidine mouthwashes.
give only TWO other causes for congestive cardiac failure.
hypertension, valve incompetence, athrelosclerosis
give THREE common classes of medication used in the treatment of congestive heart failure (do not name specific medications).
- Diuretics
- Nitrates
- ACE inhibitors
- beta blockers
The patient is to have an aortic value replaced with a metal prosthetic value. His surgeon has asked you to sign a note confirming that the patient is ‘dentally fit’ for this procedure.
D. What is usually meant by the term ‘dentally fit’ in this context?
- Patient has sufficient oral hygiene
- Patient understands that they must have a good oral hygiene
- Patient should have no active caries or no active disease in the mouth to prevent the spread of bacteraemias
which medical complication of a prosthetic value replacement is the surgeon trying to reduce by having the patient ‘dentally fit’?
Infective endocarditis
which oral organism is commonly associated with endocarditis condition?
staphylococcus aureus
what is the key role for oral hygiene instruction in the case of preventing endocarditis?
part of a highly preventative strategy to reduce the need for dental proceduces which could potentially cause a bacteraemia
hypertension – systole and diastole value
above 130/90
nifedipine, a calcium channel blocker, prescribed for hypertension causes oral side effect. What is the side effect (1)
gingival hyperplasia
Name another two drugs that could cause gingival hyperplasia
anticonvulsants and immunosuppressants
how to manage gingival overgrowth caused by calcium channel blocker
Laser excision = lasers to remove inflamed gum tissue.
Electrosurgery = applied electric currents to cut or remove what has overgrown.
Periodontal flap surgery.
Gingivectomy.
Give an oral complication of ACE inhibitors
loss of taste
give a dental complication for thiazide diuretics.
dizziness when standing after sitting or lying
dry mouth
signs of sirs
Fever or hypothermia (body temperature above 100.4°F or below 96.8°F)
Tachycardia (heart rate above 90 beats per minute)
Tachypnea (respiratory rate above 20 breaths per minute)
Leukocytosis or leukopenia (white blood cell count above 12,000 cells/mm3 or below 4,000 cells/mm3, respectively)
Increased levels of C-reactive protein (CRP) or procalcitonin (PCT)
Hypotension (systolic blood pressure below 90 mm Hg or a decrease of 40 mm Hg from baseline)
Altered mental status
Decreased urine output
