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.
