ELFH - cardiac challenges for dental practitioner Flashcards
What are the to broad categories for treatment relating to IHD?
ACUTE
LONG-TERM
What is the acute treatment for IHD?
is that of a cardiac chest pain and is covered under emergencies.
What is the long-term management of IHD?
ims to reduce modifiable risk factors:
- lifestyle adaptations including regular exercise and a healthy balanced diet
- smoking cessation
- good BP control
- good diabetic control
- reduction of cholesterol; changes in diet or pharmacological
When are medications added to the treatment of IHD?
Where long-term cardiovascular risk is significant, the patient has experienced a myocardial infarction recently, or is experiencing ongoing angina
medications can be added to try and reduce this risk and prevent progressive stenosis and eventual myocardial infarction.
Examples of medications for long-term treatment of IHD?
ASPIRIN
STATINS
ACE INHBITORS
The role of aspirin?
Aspirin, clopidogrel or newer oral anti-platelets (for example, Prasugrel and Ticagrelor) work by inhibiting circulating platelets from forming a clot, reducing the risk of complete obstruction of the coronary arteries by a thrombus.
The role of statins?
Statins help to reduce low density lipoproteins (LDL), a product of cholesterol metabolism, by inhibiting the enzyme hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase) responsible for its production.
The role of ACE inhibitors?
In addition to reducing BP, ACE inhibitors and β-blockers have been shown to have an independent positive effect on prognosis.
What enzyme o statin inhibit?
hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase)
resposniosbe for LDL production
If treatment is not working for IHD and pt still experiencing pain, what is the gold standard treatment
percutaneous angioplasty
Where this fails or many coronary arteries are obstructed, a coronary artery bypass graft (CABG) is undertaken.
What is a percutaneous angioplasty
This involves the insertion of a stent via a peripheral artery into the stenosed coronary artery to keep it patent
What is CABG?
coronary artery bypass graft
What is a coronary artery bypass graft?
A vein, usually harvested from the patient’s leg, is used to replace the coronary arteries
What is a common but not inevitable result of IHD?
congestive cardiac failure (CCF), also known simply as ‘heart failure’
What is heart failure and pt symptoms?
where the oxygenated blood pumped out from the heart is inadequate to meet the metabolic demands of the body.
This mismatch can result in a variety of symptoms, the commonest being fluid retention in dependent areas such as the legs and, more significantly, in the lungs.
Patients subsequently have difficulty breathing, and are unable to lie flat. They have poor exercise tolerance, also limited by difficulty breathing. In the severest form, patients are short of breath at rest and are unable to mobilise at all.
What is the prognosis of CCF?
Poor
with an estimated 80% 5-year mortality.
Apart from IHD, what are other causes of heart failure?
high blood pressure, dysrhythmias and valvular disease (both stenosis and regurgitation).
When the heart muscles become inlarged due to repeated stress, what are the pt symptoms?
experiences symptoms of shortness of breath, fluid retention and general lethargy.
Other symptoms and signs include:
- cough with frothy blood
- palpitations
- headaches swollen ankles
- loss of appetite
- occasional jaundice
- ascites
- raised jugular venous pressure
What is a medication ladder in CCF?
in which different classes of drugs are progressively introduced depending on the severity of the CCF.
What is the use of diuretics in CCF?
used to offload the extra fluid retained in the body. The most commonly used agent is furosemide, a loop diuretic.
What is the use if ACE- inhibiters and b-blockers in CCF?
different class of diuretic (aldosterone antagonists) are used to promote cardiac function and improve the patient’s prognosis.
What is the only definitive tx for CCF?
HEART TRANSPLANT
Does a pt with CCF need to be in a different position in the dental chair?
yes
will have difficulty lying flat so care should be taken when positioning patients
Can ineffective heart function effect other organs?
yes, result with congestion of the liver
What can congestion of the liver lead to?
liver damage or even
cirrhosis
With a pt with CCF, what should you have to consider in relation to dentistry?
clotting disorders and the ability to tolerate follow-up medication, as toxicity can have serious side-effects.
Two particular classes of drugs to be cautious with:
analgesics
antibiotics
What are aldosterone antagonists also known as?
potassium sparing diuretics
How does IHD present?
Usually presents as chest pain with possible nausea, vomiting and shortness of breath
How does CCF usually presnt?
Symptoms include shortness of breath, fluid retention and general lethargy
What may hypertension lead to?
May lead to damage to the arteries, heart muscle, kidneys and eyes
What does hypertension involve?
Involves changes in the sensitivity of specialised pressure receptors within blood vessel walls
Why does heart size increase in CCF?
In CCF, the excess fluid retention associated with heart failure causes increased volume of blood within the heart. This causes the heart muscle to stretch and in turn heart size increases. There is no increase in muscle mass in CCF.
