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2nd year > HEART-cardiovascular medicine > Flashcards

HEART-cardiovascular medicine Flashcards

1
Q

What are the main risk factors of cardiovascular disease?

A

smoking and genetics

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2
Q

compare primary and secondary prevention

A

primary prevention is before the patient gets the disease

secondary prevention is preventing the disease from getting worse after they get it.

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3
Q

How do we prevent cardiovascular disease in our patients?

A
  1. lifestyle change
  2. Cholesterol control (reduction in diet or by statins)
  3. hypertension control (we want to reduce it below 140/85)
  4. Anti-platelet drugs e.g. aspirin
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4
Q

what drugs can we use to prevent further cardiovascular disease?

A

anti-platelets

lipid lowering drugs

anti-arrythmics

Anti-coagulants

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5
Q

what drugs can we use to reduce the symptoms of cardiovascular disease?

A

diuretics

anti-arrythmics

nitrates

calcium channel blockers

ACE inhibitors

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6
Q

what are anti-platelet drugs?

A

Anti-platelet drugs prevent the platelet sticking to the vessel wall.

They are used to reduce the chance of a stroke or heart attack

e.g. aspirin/ Clopidogrel/ Dipyridamole.

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7
Q

how does aspirin work?

A

Aspirin inhibits platelet aggregation by altering the balance between thromboxane A2 and prostacyclin.

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8
Q

How does Clopidogrel work?

A

Clopidogrel is an anti-platelet that inhibits ADP induced platelet aggregation.

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9
Q

How does Dipyridamole work?

A

This is an anti-platelet that inhibits platelet phosphodiesterase.

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10
Q

What is the main concern of a dental patient who is on anti-platelet drugs?

A

The anti-platelet drug means the patient’s platelets will not work to clot the blood. So the patient would bleed out during an extraction.

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11
Q

What are anti-coagulants?

A

Anticoagulants reduce the clot formation but have no effect on the platelets.

These are used to treat a patient that innappropriately forms clots.

e.g. warfarin or NOAC- Rivaroxiban/ Aoixaban/Dabigatran

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12
Q

Compare warfarin to the NOACs

A

Warfarin requires a blood test every fornight to check if the dosage is effective. NOAC have a set dosage for the average patient.

Warfarin requires a few days to work (have to use up leftover clotting factors) whereas NOAC can be used immediately.

Patients on warfarin have to stay in hospital until it works (increased clotting risk to begin with) whereas NOAC can be taken at home.

Warfarin takes 2-3 days to stop whereas NOAC is stopped rapidly

We assume all drugs interact with warfarin whereas NOACS are safe with dental antibiotics, antifungals/ LA. Neither are safe with NSAIDs

Warfarin is a cheaper drug but NHS costs makes it more expensive than NOACS

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13
Q

What are lipid lowering drugs?

A

Lipid lowering drugs that stop you making cholesterol (lower blood cholesterol)

E.g. statins

HMG coA reductase inhibitors
Lowers production of bad cholesterol (LDL) and increases production of good cholesterol (HDL)

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14
Q

What are beta 1 blockers used for ?

A

Slowing down the heart by reducing heart muscle excitation.

A reduction in the heart electrical excitability reduces the risk of cardiac arrhythmias. (reducing the abnormal heart rythms that lead to heart attacks)

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15
Q

what are beta 2 blockers used for?

A

These make the patient less anxious but will also increase their risk of asthma (there are beta2 receptors in the lungs)

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16
Q

What are Diuretics?

A

These drugs make you pass water.

They are used to treat heart failure and be anti-hypertensive.

By increasing salt and water loss which reduces plasma volume and reducing the cardiac load.

17
Q

What are nitrates?

A

These drugs cause the blood vessels to dilate, reducing blood pressure.

Dilation of the veins- reduces preload to the heart

Dilation of the resistance arteries reduces cardiac workload and cardiac oxygen consumption

Dilation of the collateral coronary artery supply to reduce anginal pain

e.g. isorbide mononitrate

18
Q

How does isorbide mononitrate work?

A

It prevents angina pectoris through dilation of the veins. This gets more blood into the heart.

19
Q

what are calcium channel blockers?

A

Calcium channel blockers are used to treat hypertension by blocking the calcium channels on smooth muscle.(reduces strength of contraction)

20
Q

What is this?

A

Gingival hyperplasia (lumpy fibrous gums) which people on calcium channel blockers are at risk of.

21
Q

What are ACE inhibitors?

A

These are used to reduce blood pressure plus reduce salt and water retention.

By stopping the production of angiotensin converting enzyme. Preventing the production of angiotensin II that increases blood pressure.

22
Q

What is atheroscleorosis?

A

The narrowing of blood vessels as a result of cholesterol deposits. (Atheroma).

23
Q

What is Hyperlipidaemia?

A

This is high cholesterol in the blood and is an important risk factor for atherosclerosis.

24
Q

How is an atheroma formed?

A

Endothelial damage increases permeability to allow the movement of lipids into the tunica media. Macrophages move in to form foamy cells & smooth muscle proliferation occurs.

Fibrous tissue forms over the lipid producing an atheroma.

25
Q

What is an aneurysm?

A

Abnormal dilation of the blood vessel. This can lead to weakening of the blood vessel walls so could cause rupture of the vessel when it dilates.

26
Q

What is this?

A

Haemangioma-A Tumour of blood vessels.

27
Q

What is this?

A

A vascular malformation

28
Q

Compare a vascular malformation to a haemangioma

A

Vascular malformations are present at birth and persist through life.

Haemangiomas grow in the first few weeks of life but regress after about 10 years.

29
Q

What is this?

A

Sturge-weber syndrome.

(Does not cross the midline)

30
Q

What is this?

A

Kaposi Sarcoma.

This is a malignant tumour of the lympatics and blood vessels which is caused by Herpes virus 8.

31
Q

Discuss Haemangiomas in dentistry?

A

Patients can have haemangiomas located under the jaw bone. This means there is a large pool of blood so extractions would have to be completed in a hospital.

32
Q

What does valvular Heart disease cause?

A

Stenosis (injury preventing the valve opening)

Insufficency (inability to close the valve).

Vegetation (Lumps on the valve cusps)

33
Q

What does this image show?

A

Vegetations on the endocardium (valve surface)

and lots of inflamatory cells.

2nd year (63 decks)

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