Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MED COMP PTS > CVD part 2 > Flashcards

CVD part 2 Flashcards

1
Q

HF defined

A

decreased pumping action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HF systemic effects

A

systemic fluid congestion and failure of vital organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

results of RSHF

A

➢ Pulmonary edema
➢ Coughing
➢ Peripheral edema (arms and legs mostly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

results of LSHF

A

➢ Affects all organ systems;decreased kidney function contributes to fluid rentention
➢ Pulmonary edema
➢ Coughing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

pathophysiology of HF

A

*Increased workload →problems with cardiac muscle
*Left ventricle typically fails first →can lead to right ventricle failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

common signs and symptoms of HF
➢breathing
➢Inspiratory
➢heart rate
➢jugular (neck) veins
➢edema
➢Abdomen
➢skin
➢Weight
➢fingers

A

➢Rapid, shallow breathing
➢Inspiratory rales (crackles)
➢Increased heart rate
➢Distended jugular (neck) veins
➢Peripheral edema
➢Ascites
➢Cyanosis
➢Weight gain
➢Clubbing of fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

pt with Hx MI <1month
consider?
mesurement?

A
  • Consider severity of cardiac status and comorbidities
  • Ejection Fraction can measure the degree of heart failure
    ➢Measures amount (%) of blood that leaves the left ventricle after contraction. normal=55-70%, down to 40% considered slightly below normal
  • Consider appropriate management protocols
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

systolic vs diastolic HF LVEF

A

*Systolic failure➢ Reduced left ventricular ejection fraction (HFrEF)
*Diastolic failure ➢ Normal left ventricular ejection fraction (HFpEF)??

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

cardiac abnormalities contribtuing to HF

A

➢ Valvular Disease
➢ Arrhythmias
➢ Myocardial necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

decompensation of HF

A

➢ Inability to compensate
➢ Increased peripheral blood flow
➢ Increased metabolic needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

predisposing factors of HF

A

➢ Acute CVD
oMI
➢ Chronic CVD
oHypertension
oCoronary artery disease
oArrhythmia, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

complications of HF

A

➢ Cardiac arrest (stops beating)
➢ Myocardial infarction (blood flow blocked)
➢ Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

clubbing of fingers

A

shortening and rounding of the most distal phalanges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what pts may state as symptoms regarding HF

A

➢Fatigue and weakness
➢Orthopnea –shortness of breath (dyspnea) in
recumbent position
➢Exercise intolerance
➢Muscular fatigue
➢Weight Gain
➢GI distress - nausea, vomiting & constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

HF stages for management

A

stages A-D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

stage A HF, therapy

A

pts w/ HTN, DM, obesity, athersclerosis, metablic syndrome, using caridotoxins
ACEi or ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

stage B HF, therapy

A

previous MI, LV remodel, asym valve dx
ACEi or ARB
B blocker in some pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

stage C HF, therapy

A

structural heart dx, SOB, fatique, reduced exercise tolerence
diuretics
ACEi
ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

stage D HF, therapy

A

pts with symptoms at rest, recurrent hospitalizations
similar drugs as A,B,C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

medical management of HF

A
  • Pharmacologic and non-pharmacologic
  • Patients with severe heart failure may require cardiac transplantation
  • Intermediate therapy is the Left Ventricular Assist Device (LVAD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Effect of dental treatment before cardiac valve surgery:

A

Results
* LVAD studies did not meet inclusion criteria
* Low certainty evidence for valvular surgery
* Data cannot support or refute efficacy of dental
treatment (clearance) prior to cardiac surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In most cases of HF, the dentist will need to obtain a medical consultation with the patient’s cardiologist to determine:

A
  • The patient’s physical status
  • Laboratory test results
  • Level of control
  • Compliance with medications and recommendations
  • Overall stability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

major issues for patients with symptomatic HF (risks)

A
  • Symptoms could abruptly worsen
  • Acute failure
  • Fatal arrhythmia
  • Stroke
  • MI
    Does the BENEFIT of providing dental treatment outweigh the RISK of potential complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

NYHA HF classes

which do we tx?

A

Class I: routine dental care ok
Class II: medical consultation required, routine dental care likely ok
Class III and IV: consider referral to specialized care
PREP for emergency CPR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Additional HF Dental Management Considerations
* appt length
* Chair position
* If patient taking digitalis glycoside (digoxin)

A
  • Short, “stress-free” appointments
  • Chair position
    ➢Patients with HF may not tolerate supine position (pulmonary edema)
  • If patient taking digitalis glycoside (digoxin) –positive inotrope
    ➢Epinephrine should be avoided, if possible
    ➢Combination increases the risk for arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

does HF have oral manifestations

A
  • There are no oral manifestations related to HF
  • Many of the drugs used to manage HF can cause dry mouth altered taste and oral ulcerative lesions (discussed previously)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

valvular dx

A
  • Compromised function of the heart valves
  • Valves direct blood flow into different heart chambers
    ➢ Atrioventricular:
    oTricuspid and Mitral
    ➢ Semilunar
    oAortic and Pulmonary
28
Q
  • Valvular Stenosis
A

➢ Do not open properly

29
Q
  • Valvular Insufficiency
A

➢ Do not close properly
➢ Associated with regurgitation

30
Q

valvular fibrosis

A

➢ Stiff, sclerosis, stenosis causing either stenosis or insufficency

31
Q

Myxomatous degeneration

A

➢ Benign loose CT tumorous changes where valves become Floppy, prolapse, regurgitation
➢ Causes insufficiency

32
Q

Valvular dx risk factors

A

same as the other conditions

33
Q

additional valvular dx risk factors

A
  • Calcifications
  • Congenital defects (bicuspid aortic valve, mitral valve prolapse)
  • Infections
34
Q

Valvular heart dx signs

A

➢ Murmurs
➢ Syncope
➢ Heart failure
➢ Shortness of breath

35
Q

valvular heart dx symptoms

A

➢ Heart failure symptoms
➢ Exercise intolerance
➢ Shortness of breath (can also be a sign)

36
Q

Valvular Heart Disease
Medical Management

A
  • Treatment is primarily surgical
  • Valve replacement (more common)
    ➢Mechanical Implants
    oSilicone
    oRequires long-term anticoagulation
    ➢Bioprosthetic Implants
    oAllograft , bovine graft, etc.; decellularized CT
    with a less antigenic structural matrix
    oshort-term anticoagulation
    oLong-term antiplatelet therapy)
  • Predisposition for infective endocarditi
37
Q

mechanical vs bioprosthetic valve implants Abx

A

mechanical: long term Abx
bioprosthetic: short term Abx

38
Q

Questions for Patient with Valvular Heart Disease
screening?
replacement?
anticoag?

A
  • Screening
    ➢ Shortness of breath, chest pain, etc.
  • Valve replacement
    ➢ Have you ever had valve replacement surgery ? Know type of valve and when
  • Anticoagulation/Bleeding
    ➢ Do you take a blood thinner?
    ➢ Do you take aspirin or clopidogrel (Plavix)?
    ➢ Does it take a long for you to stop bleeding after a cut?
    ➢ Have you ahd excessive bleeding during or after a dental appointment?
    ➢ Have you ever been hospitalized due to bleeding?
  • Previous Infective Endocarditis
    ➢ Have you ever had infective endocarditis? when, tx, adverse rxn to drugs?
39
Q

does valcular dx have oral manifestations

A

no

40
Q

bleeding issues with valve dx

A

➢ Complications from anticoagulation or
➢ Complications from antiplatelet therapy

41
Q

infection risks with valve dx

A

➢Risk of developing infective endocarditis
➢Requires antibiotic prophylaxis when valves have been replaced

42
Q

drug effects of valve dx

A

➢ Potential drug interactions from CVD pharmacologic management (as previously discussed), especially when comorbidities are present

43
Q

Valvular Heart Disease
Dental Considerations
bleeding, infections, drugs

A
  • Assess ability to tolerate care in context of underlying condition and comorbidities
  • Assess Bleeding Risk
    ➢ Obtain INR the day of the invasive procedures
    ➢ Have local hemostatic measures in place
  • Infections
    ➢Determine need for antibiotic prophylaxis and antibiotic of choice
  • Drug Effects
    ➢ Review medication list (drug adverse effect/drug-drug interactions)
44
Q

IE

A

infection of inner layer of the heart usually affecting the valves

45
Q

IE precipitated by:

A

bac/fungal infection

46
Q

IE death can be caused by:

A

emboli and valvular dx

47
Q

etiology IE

A

blood turbulence in heart can allow microbe to infect damaged endothelial surfaces

48
Q

IE pathophys diagrammed

A
49
Q

AHA Cardiovascular Indications for Antibiotic Prophylaxis to prevent IE

A
  • Prosthetic cardiac valves
  • Prosthetic material used for cardiac valve repair
  • Previous endocarditis
  • Cardiac transplantation recipients with valve regurgitation due to a structurally abnormal
    valve
  • Congenital heart disease (CHD) only in the following categories:
    ➢Unrepaired cyanotic CHD
    ➢Completely repaired congenital heart defect with prosthetic material or device, during the first six months after the procedure
    ➢Repaired CHD with residual shunts or valvular regurgitation at the site or adjacent to the
    site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
50
Q

those at high risk for IE

A
51
Q

moderate risk for IE

A
52
Q

low risk for IE

A
53
Q

Antibiotic prophylaxis is recommended for ONLY AT RISK PATIENTS who have procedures that:

A
  1. Manipulate the gingival tissue
    2.Manipulate the periapex of teeth
    3.Perforate the oral mucosa
54
Q

If the dosage of antibiotic (prophylaxis) is inadvertently not administered before the procedure, the dosage may be administered:

A

may be administered up
to 2 hours after the procedure.

55
Q

most common prophylaxis drug and dosage

A

oral amoxicillin 2mg (adult), 50mg/kg (child)

56
Q

pt unable to take oral Abx prophylaxis

A

ampicillin 2mg IV/IM OR
cefazolin/ceftriaxone 1mg IV/IM

same 50mg/kg for kid

57
Q

allergy to penicillin/ampicillin, what should pt take to prophylaxis

A

cephalexin 2g (50mg/kg)
clindamycin 600mg (20mg/kg)
azithromycin/clarithromycin 500mg (15mg/kg)

58
Q

IE Patients already taking antibiotics urgent vs elective care

A

If a patient is taking a beta-lactam (penicillin, amoxicillin, etc.) for an active, existing infection resistant strains have likely been selected
* If urgent/emergency dental treatment is necessary
➢ Prescribe azithromycin or clarithromycin

  • If dental treatment is elective
    ➢ Wait 10 days after completion of the antibiotic for their active infection, then prescribe amoxicillin according to AHA guidelines
59
Q

Conditions that DO NOT require Antibiotic Prophylaxis

A

Heart murmur
* Mitral valve prolapse
* Mitral valve prolapse with regurgitation
* Rheumatic fever
* Stent or coronary artery bypass graft (cabg)

  • Note: If a heart murmur is due to specific cardiac condition (e.g., previous endocarditis, prosthetic heart valve, complex congenital cyanotic heart disease), AHA continues to recommend antibiotic prophylaxis for most dental procedures
60
Q

Procedures that DO NOT require Antibiotic Prophylaxis

A
  • Radiographs
  • Placement of appliances
  • Routine local injections
  • Tooth shedding or trauma
61
Q

predictor of IE chances

A

*Size of bacteremia or bacteria number is a predictor of IE chances

62
Q

is IE only bacterial

A

*Infective endocarditis (IE) is not always caused by bacterial infection

63
Q

*Continuing evidence and Abx prophylaxis

A

*Continuing evidence questions the validity of antibiotic prophylaxis practice to prevent IE

64
Q

majority of IE due to?

A

*Daily exposure to bacteremias during everyday activities (toothbrushing, chewing)
likely cause most cases of IE; not dentistry

65
Q

how can we help prevent IE

A

*Encourage good oral hygiene practices

MED COMP PTS (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions