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BDS2 BAMS > chronic CVS diseases > Flashcards

chronic CVS diseases Flashcards

1
Q

what are values of bp to be considered hypertension

A
  • higher than 140/90
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2
Q

risk factors for hypertension

A

age
smoking
alcohol
genetics
pregnancy
stress
drugs

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3
Q

which drugs could cause hypertension

A

o NSAIDs
o corticosteroids
o oral contraceptives

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4
Q

Possible causes of hypertension

A
  • Phaeochromocytoma
  • Cushing’s syndrome
  • Renal artery stenosis
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5
Q

what is cushings syndrome

A

salt and water retention leading to excess fluid and hypertension

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6
Q

what is Renal artery stenosis

A

o usually a result of atherosclerosis
o narrowing of blood flow into kidney
o In response to this reduced blood flow, the kidneys activate RAAS#
o increase in aldosterone and angiotensin II
o increase in water and salt retention; vasoconstriction
o hypertension

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7
Q

What can happen after you have hypertension

A
  • atherosclerosis
  • MI
  • stroke
  • peripheral vascular disease
  • renal failure
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8
Q

CVS Diseases linked to hypertension

A
  • cerebrovascular accident stroke
  • coronary heart disease
  • heart failure
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9
Q

does treating hypertension decrease the risk or effects of coronary heart disease?

A

no
treating hypertension has very little effect on coronary heart disease because reversing pressure does not reduce the amount of plaque that has bult up in the coronary arteries over the years

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10
Q

does treating hypertension decrease the risk of heart failure

A

yes, lesser workload on heart

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11
Q

what is heart failure

A

o heart failure is when the heart is unable to pump blood around the body

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12
Q

Investigations for hypertension

A
  • urinalysis
  • serum biochemistry
  • serum lipids
  • ECG
  • cortisol or adrenaline levels
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13
Q

Treating hypertension

A
  • modify risk factors
  • drug
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14
Q

what drugs are used to treat hypertension?

A

diuretics
beta blocker
calcium channel antagonist
ACE inhibitors

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15
Q

side effects of diuretics

A

gout and xerostomia

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16
Q

side effect of b blocker

A

worsen heart failure
worsen asthma and copd

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17
Q

side effect of calcium channel antagonists

A

cause gingival hyperplasia

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18
Q

side effects of ACE inhibitors

A

angiodema
 Oral mucosa and upper airways including swelling of the lips, tongue, and floor of mouth

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19
Q

4 types of heart failure

A

high/low output

left/right heart failure

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20
Q

what is high output heart failure

A

demands of the system have increased beyond the capacity of the pump

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21
Q

causes of high output heart failure

A

anaemia - o2 capacity reduced
thyrotoxicosis - increased metabolism-> increased o2 requirement

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22
Q

what is low out heart failure

A

pump is failing

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23
Q

what happens when the ventricles become enlarged or stiff

A
  • enlarged ventricles -> ventricles pump out less than 40-50% of the blood
  • stiff ventricles -> ventricles pump out 60% of blood but the total volume is less than the volume of normal heart
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24
Q

causes of low output heart failure

A

cardiac defect

valve disease

heart muscle disease
MI
myocarditis

pressure overload
hyper tension
aortic stenosis (valves)

volume overload

arrhythmia
afib
heart block

drugs beta blocker

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25
Q

when looking at signs and symptoms of heart failure, how to differentiate between left and right heart failure?

A
  • left heart failure
    o lungs accumulate fluid
    o systemic tissues
  • right heart failure
    o venous pressure elevated
    o systemic veins
    o fluid transudation from veins into tissues
    o swollen ankles
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26
Q

pitting oedema suggests what

A

right heart failure

*for pitting oedema, the higher the pitting is found along the leg, more severe failure

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27
Q

Treatment of heart failure

A

acute emergency lungs filled with fluid -> use high dose diuretic to remove fluid

chronic ->
o improve myocardial function
o reduce compensation effects
o treat underlying causes
o drug therapy

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28
Q

drugs used for chronic heart failure

A

diuretics

ace inhibitors

inotropes digoxin – improves heart efficiency and control electrical activity

nitrates – reduce venous filling pressure, reduce fluid transudation from veins to tissues, reducing swelling

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29
Q

whats a negative inotype

A

inotropy is the strength of heart pumping

beta blockers are a negative inotrope so it can worsen heart failure, heart fails as a pump

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30
Q

which valves are more likely to have problems in valve disease

A
  • mitral valve ie bicuspid
  • aortic valve
31
Q

valve stenosis

A

narrowing of the valve opening, unable to open

32
Q

valve insufficiency

A

unable to close

33
Q

Causes of valve diseases

A

congenital

MI

rheumatic fever->vegetations

dilatation of aortic root->valve cant close, might rupture and lead to aneurysm

34
Q

when to use Doppler ultrasound scan

A

valve disease
congeintal heart disease

35
Q

Treatment for valve disease

A
  • valve replacement with prosthetic valves
36
Q

what drug do you prescribe for stents and prosthetic valves

A

stent - aspirin

pros valve - warfarin

37
Q

metal vs porcine valves

A

metal longer lifespan but need warfarin

both might need AB prophylaxis

38
Q

recognize sinus, asystole, ventricular fibrillation

know about atrial fibrillation and ECG of MI

A
39
Q

whats Afib and Atrial tachycardia

A

atrial tachycardia can lead to atrial fibrillation

With Afib, electrical impulses fire from multiple sites in both atria instead of the single SAN. That can cause the atria to contract 400 or more times per minute

40
Q

which arrythmia has narrow QRS complex

A

afib

41
Q

which arrythmia has broad QRS complex

A

ventricular tachycardia

42
Q

why is Afib less dangerous than VT/VF

A

Ventricles all activated at the same time so still not as bad as ventricular tachycardia

43
Q

ventricular tachycardia-> ventricular fibrillation -> death

A
44
Q

what happens during ventricular fibrillation

A

ventricle muscles not contracting together, contracting at different paces at different times

no ability to produce a cardiac output

requires defib

45
Q

when is defib used

A

defib used for VF,VT,PVT
- defib cannot sense asystole, it requires existing electrical activity , cannot generate any electrical activity

46
Q

two types of bradyarrhythmia

A

heart block
drug induced( beta blocker)

47
Q

whats heart block

A

little to no conduction through SAN -> AVN;

ventricle has independent pulse of about 30bpm

48
Q

what does the ecg of a heart block look like

A

prolonged PQ intervals

49
Q

how many degrees of heart block

A

3
3rd being complete heart block

50
Q

Treatment of bradyarrhythmia

A
  • pacemakers
  • has a sensing circuit
  • pacing circuit
51
Q

what is the relation between pacemakers and dental

A
  • electrical fields, MRI, some dental equipment, induction scalers cannot be used as they might cause sensing circuit to shut down
52
Q

when to suspect congenital heart diease

A
  • suspect with any congenital defects like cleft lip, down syndrome
53
Q

3 types of congenital heart disease

A
  1. Atrial septal defect
  2. Ventricular septal defect
  3. Patent ductus arteriosus
54
Q

is atrial and ventricular septal defect cyanotic?

A

no, blood is still oxygenated

55
Q

what can atrial defect lead to

A

may lead to heart failure or atrial hypertrophy

due to increased workload of recirculating the blood through lungs

56
Q

what can ventricular defect lead to

A

higher risk of endocarditis due to turbulent blood flow

higher risk of heart failure

57
Q

Patent ductus arteriosus

A

ductus fails to close

blood flows from aorta into pulmonary artery

blood simply recirculating ; no cyanosis

increased cardiac workload which may lead to heart failure

58
Q

Signs and symptoms of congenital heart disease

A

finger clubbing
central cyanosis not peripheral

59
Q

cyanosis definition

A

o more than 5g/dL of deoxygenated Hb in the blood
o poor blood flow through lungs to tissues

60
Q

warm tissues look blue in colour

tongue and lips looks blue

what could be happening

A

central cyanosis, congenital heart disease, mixing of oxy and deoxy blood

61
Q

Treatment of congenital heart diseases

A
  • septal defects may close naturally with time
  • open heart surgery to close defect
  • insertion of mesh
  • AB prophylaxis for some dental procedures can be considered
62
Q

Infective Endocarditis def

A
  • infection and inflammation of the endocardium
  • usually on the valves
63
Q

cause of IE

A
  • mainly oral streptococci
  • microbial colonisation of thrombi on endocardial surface
64
Q

pathogenesis of IE

A
  • bacteria enter -> adhere to damaged endothelium/valve and thrombi -> bacterial proliferation, neutrophil and macrophage infiltration -> vegetation formation on valves usually -> haemodynamic changes -> laminar changes to turbulent flow -> more vegetations and microbial multiplication
65
Q

Who is at risk of IE

A
  • congenital heart defects
  • prosthetic valves
  • past history of endocarditis
66
Q

What dental procedures are a risk

A
  • involving dento-gingival junction
  • bacteraemia = bacteria in blood
  • extractions
  • perio therapy
  • gingival surgery
  • implants
  • restoration involving gingival margin and matrix bands
67
Q

Who is not at risk of IE

A
  • CABG
  • angioplasty and stent
  • pacemakers
  • defib
68
Q

How to handle at risk patients for IE?

A
  • identify the risk
  • prevention of oral disease
  • let them know that AB prophylaxis is no longer routinely administered
  • consult cardiologist if they are at risk
69
Q

side effects of AB prophylais

A
  • AB prophylaxis may cause side effects like risk of hypersensitivity for ppl with penicillin allergy, anaphylactic shock, increase risk of CDI (C.difficile infection)
70
Q

what does NICE, ESC AND AHA say about AB prophylaxis

A

NICE=AB ineffective
ESC and AHA= AB effective

71
Q

when should you as a dentist give AB prophy

A
  • prescribing AB prophylaxis should be made by patient and their cardiologist
  • communicated to dentist in writing
  • only used for procedures that may produce bacteraemia eg manipulation of dento gingival junction
72
Q

dosage of AB prophylaxis

A

3mg amoxicillin 1h before procedure

73
Q

Valve defects are common is who?

A

Elderly and Down syndrome

BDS2 BAMS (27 decks)

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