Exam 2 Powerpoint Flashcards
What is Cardiac Arrhythmia?
Variation in the normal heartbeat: rhythm, rate or conduction pattern of heart is distrubed.
Cardiac Arrhythmia is influcenced by ?
- Strong emotions
- Certain drugs
Cardiac arrhythmia can lead to ?
anxiety, loss of consciousness, possible death
Who are at risk for cardiac arrthymias?
- Older adults
- Long term smokers and drinkers
- People with Ischemic heart disease
- Taking certain drugs and specific systemic diseases
What are the drugs/food that can induce tachycardia?
- Atropine
- Epinephrine
- nicotine
- Ephedrine
- Caffeine
What are the drugs/food that can induce bradycardia?
- Digitalis
- Morphine
- Beta-blockers
- Calcium channel blockers
What are the common conditions for cardiac arrhythmias?
- Primary cardiovascular disorders
- Pulmonary disorders
- Autonomic disorders
- Systemic Disorders
- Drug-related adverse effects
- Electrolyte imbalances
What is the etiology for cardiac arrthymia?
- Occurs when the electrical signals that coordinate heartbeats do not work correctly
- may cause the heart to beat too fast or too slow
What are the arrhythmia symptoms ?
- Rapid heartbeat or irregular heartbeat
- A fluttering feeling in your chest
- Chest pain trouble breathing
- Weakness
- Dizziness or light headedness
- Fainting
- Fatigue
- Sweating
what are the medical management for cardiac arrhythmias ?
- meds are the first
- calcium channel blockers, beta blockers, postassium channel blockers drugs of variable mechanisms oral anticoagulants
- Other treatment options are implemented if medications are not effective
- Cardioversion implanted pacemakers, implantable carioverter-defrib, radiofrequency ablation and surgery.
For oral anticoagulants what increases the risk for stroke and blood clots?
Atrial fibrillation
What are direct oral anticoagulant?
- Pradaxa
- Eliquis
- Xarelto
What are the dental management for cardiac arrhythmias?
- Thorough Medical Hx, Vital signs to identify patients at risk
- Known history of arrhythmia
- Consult with physician if symptoms are present or if pulse is irregular
**No premedication needed **
- short , morning appts for complex procedures
- Employ stress reduction protocols
- anesthesia with vasoconstrictor is safe, only 2
- Oral anticoagulants bleeding is a consideration, obtain recent INR between 2-3.5
What is congestive heart failure?
caused by inability of the heart to function effeciently as a pump
- decrease in cardiac output
- incomplete filling or emptying of the ventricle
If Congestive heart failure is poorly managed or goes untreated what happens?
Cardiac arrest, stroke and myocardial infraction
What is the most common cause of heart failure?
- Coronary heart disease
- Hypertension
- Cardiomyopathy
- Valvular heart disease
- Myocarditis
- Infective endocarditis
- Congenital heart disease
- Pulmonary hypertension
- Pulmonary embolism
- Endocrine disease
What are signs of heart failure?
- Rapid shallow breathing
- Hyperventilation
- inspiratory cracking
- heart murmur
- increased heart rate
- gallop rhythm
- pulus alternans
- distended neck veins
- large liver
- jaundice
- peripheral edema
- ascites
- cyanosis
- weight gain
- clubbing of fingers
What are the symptoms of heart failure?
- dyspnea
- fatigue and weakness
- orthopnea
- paroxysmal nocturnal dyspnea
- acute pulmonary edema
- exercise intolerance
- fatigue
- dependent edema
- weight gain
- Upper right quad pain
- Anorexia
- Hyperventilation
What is the medical management for Heart failure?
- Stage A and B: do not include heart damage, identify and treat other conditions and risks, lifestyle modifications.
- Stage C: stage A and B with salt restriction and medications
- avoid NSAIDS, calclium channel blockers and antiarrhythmics.
- Stage D: mechanical and surgical treatment
What are some dental considerations for heart failure?
- Determine the risk vs benefit of treamtent by consulting with physician
- Compensated HF posses intermediate risk during dental care (Class I)
- PT who have uncompensated HF are not candidates for elective care
- Severe Class III and All Class IV Pts needs to receive care ina hospital dental clinic
- Antibiotic premedication possble for LVAD
- Avoid NSAIDS
- Anticoagulant therapy for possible excessive bleeding
- anethesia with vasoconstrictor safe for Class I or II; max 2 cartridges
What are the oral manifestations for HF ?
- No oral manifestations of HF
- Medications may cause dry mouth or oral lesions
What is hypertension?
- abnormal elevation in arterial pressure
- can be fatal if left untreated
- Clinical signs and symptoms may not be present
- Prevalence: both genders, increase with age
- Leads to damage kidneys, heart, brain and eyes
What is the etiology for primary hypertension?
No etiology: majority of individuals who have HBP
What is the etiology for secondary hypertension?
underlying conditions like
* chronic kidney or renovascular disease
* chronic steroid therapy
* narrwoing aorta
* medications
* pheochromocytoma
* adrenal gland condition
* sleep apnea
* thyroid or parathyroid disease
* white coat syndrome
What is BP classification?
- Classification and diagnosis determined by physician based on average of 2 or more readings on two or more office visits
What are the BP categories?
- Normal: 120/less and 80/less
- Elevated: 120-129 and 80/less
- High BP (Stage 1) 130-139 or 80-89
- High BP (Stage 2) 140/higher or 90/higher
- Hypertensive crisis 180/higher or 120/higher
What are the clincial predictors of increase perioperative Cardiovascular risk?
- Major: Unstable coronary syndromes, decompensated HF, major arryhthymias, sever valvular disease.
- Intermediate: HX of ischemic heart disease, HX compendated or prev HF, HX CVD, diabetes mellitus, renal insufficiency
- Minor RF: Advanced age, abnormal ECG, Rhythm other than sinus uncontrolled HBP
What are some dental considerations for Patients with Hypertension ?
- Possibility of sudden acute elevation in BP during dental appts, this can lead to stroke, heart attak and other serious outcomes.
- lower BP in the afternoon (PM appts preferred)
How to best manage stress during a dental appointment?
- By having short morning appointments
What are the oral manifestations for hypertension.
- Medications may cause dry mouth
- Lichenoid reaction possible from thiazides, methyldopa, propranolol and labetalol
medications ending in OLOL=Hyperplasia
What does ACE inhibitors do?
Delayed healing, bleeding, angioedema, cough and oral burning sensations
What does Calcium channel blockers do?
Causes gingival overgrowth
What is Ischemic heart disease ?
- Thickening of the innermost layer of the arterial wall due to accumulation of lipid plaques.
What are the most common underlying cause of Ischemic heart disease/coronary heart disease?
- angina
- Myocardinal infraction
- Stroke
- Peripheral arterial disease
What are the risk factors of Ischemic heart disease?
- Male gender
- Older age
- family history of CVD
- Hyperlipidemia
- Hypertension
- Smoking
- Physical inactivity
- Obesity
- Insulin resistance
- Diabetes
- Stress
- Depression
What are symptoms ischemic heart disease?
- Chest pain
- Heart palpitations
- Lack of blood
- Angina pectoris/chest pain lasts about 5-15 minutes, radiates in shoulder, arm, neck or mandible .
What is stable angina pectoris?
- 3-5 min consisten pain
- stops with rest, removal of cause or nitroglycerin
- Provoked by excerise or stress
- Patient can predict attack
- Med: Nitroglycerin
what is unstable angina pectoris?
- new onset of pain: different or irregular without prediction
- Increases in frequency and intensity
- may occur when at rest or exertion
- meds does not releive
- no elective dental treatment
- can lead to myocardica infraction
Whatare the medical management of angina pectoris?
- identify and treat causative conditions
- Reduce cardiovascular risk factors: HBP smoking, High Cholestrol, sedentary lifestyle, poor diert, obesity.
- Pharm: nitroglycerin, beta blockers, anticoagulant drugs, statins
- Surgery
What are the symptoms of myocardial infraction?
- Deep chest pain radiatiing to back jaw left arm
- Cold sweat, weakness, faintness, breath shortness
- Women symptoms deffer from men
- Pain is more sever and last longer than angina.
What are the oral manifestations of ischemic heart disease ?
- May be associated with periodontal disease, poor oral health and tooth loss.
- Medications may cause dry mouth, changes in taste perception and stomatitis
- Calcium channel blockers may cause gingival overgrowth
- Panoramic can detect cartoid calcification
What is infective endocarditis?
Microorganisms colonize the endothelial ( lining ) of the heart or heart valves.
What is the etiology of IE?
- caused by streptocci, staphylococci and enterococci
- Oral bacteria have often been found; dental procedures have been long-believed cause of IE.
Infective endocarditis occurs in?
- middle-age
- edlerly
- Men vs women
- Previous IE
What are the complications of IE?
- Heart attack
- abscesses
- stroke
- blood clots
- septic shock
- invasive infection
- heart failure
- death
What is the treatment for IE?
Antibiotics have been administered before invasive dental procedures to prevent these infections.
What is the current American Heart Association recommendations for prophylactic antibiotic
premedication for the prevention of bacteremia from an invasive dental procedure.
Antibiotic prophylaxis prior to dental treatment is controversial, because no data shows that it decreases in bacteria or reduces the risk or prevnt incidence of IE.
What are the signs and symptoms of IE with bacteremia?
Fever
Heart murmur
Positive blood culture
What are the dental procedures that require antibiotic premedications?
- Any that involve manipulation if gingival tissue : Calculus detection, perio probing, deposit removal.
- Any that involve manipulation of the periapical region of teeth: endodontoic procedures.
- Any that involves perforation of the oral mucosa: oral surgeries
What are the dental procedures that DO NOT require antibiotic premedications?
- Radiographs
- IO/EO
- Dental Charting without sub exploration
- Routine injections to administer anesthesia
Conditions requiring antibotic premed?
- Prosthetic cardic valves
- Congenital heart disease
- Previous relapse or recurrent infective endocarditis
- Cardiac transplant recipents who develop cardiac valulopthay
The AHA does not recommended routine antibiotic prophylaxis for PT with _____ to undergo dental procedures.
nonvalvular cardiovascular devices
