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Medically Complex > Exam 1 - Cardio > Flashcards

Exam 1 - Cardio Flashcards

1
Q

What are the coronary arteries and what part of the heart do they supply?

A
  • Left main coronary artery (LMCA)
    • Left side of heart muscles
    • Left ventrical & atrium
    • LAD - branches off and supplies front and left side of heart
    • Circumflex branches off and supplies outer side and back of heart
  • Right coronary artery (RCA)
    • Supplies blood to the right ventricle, the right atrium, and the SA (sinoatrial) and AV (atrioventricular) nodes, which regular the heart rhythm.
    • The right coronary artery divides into smaller branches, including the right posterior descending artery and the acute marginal artery.
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2
Q

What are the two types of infarctions? and which has the worst prognosis in patients?

A
  • Transmural
    • Involves all 3 layers of heart
    • Worse prognosis
  • Subendocardial
    • Usually concentric around subendocardial layer of left ventricle
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3
Q

Where are MI’s more likely to occur? What are the percentages of occlusion of blood vessels?

A
  • LAD - over 50%
  • RCA - 30-40%
  • Left Circumflex - 10-20%
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4
Q

What are the complications of MI’s (three of them)?

A
  1. Left ventricular aneurysm
    1. Massive myocardial infarcts of the left ventricle, which are replaced by granulation and fibrous tissue, bulge under the pressure of the blood in the left ventricle, forming a ventricular aneurysm. The heart is dilated and contracts irregularly because the fibrous tissue forming the wall of the aneurysm does not contract.
  2. Mural Thrombosis
  3. Left ventricular rupture
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5
Q

What is the association between oral health, atherosclerosis and possible myocardial infarcts?

A
  • Low levels of gram negative bacteria in dental caires or perio disease - effects endothelial integrity, plasma lipoproteins, and blood coagulation
  • Dental caries and ischemic heart disease
    • Low socioeconomic status, smoking, diabtets
  • Diet high in sucrose - incriminated in caries and development of atherosclerosis
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6
Q

What are some of the side effects of using certain anti-hypertensive meds?

A
  • Dry mouth and altered sense of taste (dysgeusia)
  • Gingival hyperplasia - Ca channel blockers (nifedipine)
  • Use of epinephrine (local)
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7
Q

What are the potential side-effects of using epinephrine in a hypertensive patient?

A
  1. Higher probability of a hypertensive crisis
  2. Angina pectoris (acute chest pain)
  3. Myocardial infarction
  4. Cardiac arrhythmias
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8
Q

Who are those at high risk for infective endocarditis?

A
  1. Prosthetic heart valves
  2. History of Infective Endocarditis
  3. Certain types of congenital heart defects, and prosthetic repair of congenital heart defects
  4. Valvulopathy after heart transplant

** Recommended to receive prophylactic antibiotics**

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9
Q

What dental procedures are excluded from having to pre-medicate?

A
  • Routine cleanings
  • Anesthetic injections through non-infected tissue
  • Radiographs
  • Placement/adjustment of appliances
  • Shedding deciduous teeth
  • Bleeding from lip trauma
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10
Q

What are the regimens for dental prophylaxis against IE?

A
  • Dental prophylaxis should be given 30-60 min before procedure
  • Oral amoxicillin best drug
  • Cant take orally
    • Ampicillin, cefazolin, ceftriaxone
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11
Q

What is the atherosclerosis relation to sugar and glucose?

A

High consumption of sucrose is considered an important factor in the etiology of dental caries, and has also been incriminated in the development of atherosclerosis

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12
Q

What are the differences between ABE and SBE (Organisms associated - which one is more severe)?

A
  • Acute Bacterial Endocarditis
    • S. Aureus (more severe)
  • Subactue Bacterial Endocarditis
    • S. mutans, S. mitis, S. Sanguins
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13
Q

Which side of heart are these vegetations (ABE/SBE) more likely to be found (most common complication from these vegetations)?

A
  • They most commonly present on the mitral and aortic valves - Left side
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14
Q

ABE versus SBE vs prosthetic valve endocarditis and IV drug abuse endocarditis (which organism)?

A
  • IV drug abuse - S. epidermidis
  • Prosthetic valve endocarditis- Staph epidermidis
  • Acute Bacterial Endocarditis - S. Aureus (MORE SEVERE)
  • Subacute Bacterial Endocarditis - S. mutans, S. mitis, S. Sanguins
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15
Q

What organs are involved with septic emboli left side vs right side endocarditis?

A
  • Left side
    • Brain, Heart, Spleen, Kidneys
  • Right side
    • Lungs, Brain
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16
Q

Differentiate between:

Osler’s nodes, Janeway lesions, splinter hemorrhages vs Roth’s spots

A
  • Osler’s nodes - tender, small, raised, cutaneous lesions, on pads of fingers and toes
  • Janeway lesions - small erythematous or hemorrhagic lesions on palms or soles
  • Splinter hemorrhages - linear subungual hemorrhages, seen as dark-red streaks beneath the nailbed
  • Roth’s spots - found in eyes due to retinal microemboli
17
Q

What are the 3 compensatory mechanisms to stave off congestive heart failure?

A
  1. Increased sympathetic stimulation
  2. Fluid retention
  3. Cardiac muscle hypertrophy
18
Q

What organs are involved in Left sided vs Right sided congestive heart failure?

A
  • Left Sided
    • Lungs - pulmonary edema
    • Kidney - activates RAS
    • Brain - cerebral hypoxia
  • Right Sided
    • Liver - “nut-meg liver”
    • Portal system - enlarged spleen
    • Kidney -
    • Peripheral edema -
19
Q

What is the most common cause for right sided congestive heart failure?

A

Left-sided congestive heart failure

20
Q

What are the risk factors for Primary vs Secondary hypertension?

A
  • Primary
    • Old age, race (blacks), stress, genetics, excess salt intake, obesity, alteration in RAS
  • Secondary
    • Kidney disease, vascular disorders, pheochromocytoma, alcohol consumption, medications, acute brain lesions
21
Q

What are the demographics (sex, race, age) for malignant hypertension?

A
  • Middle-aged adults >40 years (males)
  • Young black men
22
Q

What hypertension medications can cause oral complications?

A
  • Xerostomia, dysgeusia (sense of taste)
  • Gingival hyperplasia - calcium channel blockers (nifedipine)
  • Use of epinephrine

Medically Complex (5 decks)

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