chronic cvs diseases

Question 1

what is hypertension

Answer 1

raised blood pressure

Question 2

normal BP values

Answer 2

Systolic >120mm Hg
Diastolic > 80mm Hg

Question 3

symptoms and signs of left heart failure

Answer 3

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

Question 4

symptoms and signs of right heart failure

Answer 4

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

Question 5

management of heart failure

Answer 5

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

Question 6

how do you diagnose hypertension

Answer 6

BP taken on two different occasions
normal is no greater than 120/80 mmHg

do standing and relaxed values

ECG and electrocardiogram

Question 7

hypertension causes

Answer 7

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

Question 8

heart failure causes

Answer 8

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)

Question 9

benefits and disadvantages of metal heart valves

Answer 9

lifelong durable
but need anticoagulants
if done on paeds, need to be changed as patient grows
most likely to cause thrombosis

Question 10

benefits and disadvantages of bio heart valves

Answer 10

do not need lifelong warfarin therapy
but wears out sooner
most likely to be rejected by patient

Question 11

anticoagulant use for metal valves

Answer 11

the vitamin K antagonist, warfarin, is currently the only oral anticoagulant recommended for patients with aortic and mitral mechanical heart valves.

Question 12

tell me about pacemakers

Answer 12

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

Question 13

after valve replacement in dentistry

Answer 13

need to follow SDCEP anticoagulant guidance for dental care

often need to prescribe antibiotics before big treatment to reduce endocarditis risk

Question 14

A patient presents with a history of heart failure. Name all of the following symptoms which may relate only to this condition:

Answer 14

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

Question 15

What are the implications for dental care of a patient who gives a history of a prosthetic valve replacement (2)

Answer 15

Risk of infective endocarditis
Extraction complications if patient is taking anticoagulants

Question 16

which TWO heart valves are most commonly replaced? (2)

Answer 16

aortic and mitral

Question 17

how would undiagnosed Atrial Fibrillation be recognised when feeling the patient’s pulse? (2)

Answer 17

irregular beat, higher than 100 beats per minute

Question 18

Excluding valve replacements, list THREE patient groups at risk of infective endocarditis from an oral bacteraemia (3)

Answer 18

Intracardiac device – pacemaker
Patient with cardiac disease, aortic stenosis, untreated valve disease
Endocarditis history

Question 19

What oral health advice should be given to a patient at risk of endocarditis? (1)

Answer 19

Regular scaling appointments
Most of the evidence that oral organisms have big role = maintaining oral health
Moving away from antibiotics and motivate patient

Question 20

what do you understand by the terms
bacteraemia and septicaemia?

Answer 20

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.

Question 21

infective endocarditis may occur as a
complication of dental treatment — what is
infective endocarditis?

Answer 21

inflammation of the endocardium of the heart valves

inflammation of endocardium around congenital defects of the heart

Question 22

Which organisms commonly cause infective
endocarditis?

Answer 22

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.

Question 23

which patients are at risk of getting infective endocarditis from dental treatment?

Answer 23

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

Question 24

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?

Answer 24

preoperative chlorhexidine mouthwashes.

Question 25

give only TWO other causes for congestive cardiac failure.

Answer 25

hypertension, valve incompetence, athrelosclerosis

Question 26

give THREE common classes of medication used in the treatment of congestive heart failure (do not name specific medications).

Answer 26

• Diuretics
• Nitrates
• ACE inhibitors
• beta blockers

Question 27

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?

Answer 27

• 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

Question 28

which medical complication of a prosthetic value replacement is the surgeon trying to reduce by having the patient ‘dentally fit’?

Answer 28

Infective endocarditis

Question 29

which oral organism is commonly associated with endocarditis condition?

Answer 29

staphylococcus aureus

Question 30

what is the key role for oral hygiene instruction in the case of preventing endocarditis?

Answer 30

part of a highly preventative strategy to reduce the need for dental proceduces which could potentially cause a bacteraemia

Question 31

hypertension – systole and diastole value

Answer 31

above 130/90

Question 32

nifedipine, a calcium channel blocker, prescribed for hypertension causes oral side effect. What is the side effect (1)

Answer 32

gingival hyperplasia

Question 33

Name another two drugs that could cause gingival hyperplasia

Answer 33

anticonvulsants and immunosuppressants

Question 34

how to manage gingival overgrowth caused by calcium channel blocker

Answer 34

Laser excision = lasers to remove inflamed gum tissue.
Electrosurgery = applied electric currents to cut or remove what has overgrown.
Periodontal flap surgery.
Gingivectomy.

Question 35

Give an oral complication of ACE inhibitors

Answer 35

loss of taste

Question 36

give a dental complication for thiazide diuretics.

Answer 36

dizziness when standing after sitting or lying
dry mouth

Question 37

signs of sirs

Answer 37

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