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Dental Mgmt of Medically Compromised Pts > Heart Failure, Infective Endocarditis, and Valvular diseases > Flashcards

Heart Failure, Infective Endocarditis, and Valvular diseases Flashcards

1
Q

Which ventricle of the heart typically fails first?

A

Left Vent

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2
Q

How is the size of heart and effectiveness of the heart changed in heart failure?

A

Increase in size with decrease in effectiveness

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3
Q

_____ can measure the degree of heart failure

-Measures amount (%) of blood that leaves the left ventricle after contraction

A

Ejection Fraction

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4
Q

What is the Ejection Fraction (%) range that is considered normal?

A

55-70%

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5
Q

How is ejection fraction calculated?

A

[Blood volume pumped out/ blood volume in chamber] x 100

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6
Q

If the ejection fraction is between 41-49%, what does it say about extent of heart failure?

A

Borderline HF: warning signs

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7
Q

If EF is less than ___%, it signifies that HF is likely

A

Less than 40%

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8
Q 
Signs of \_\_\_\_\_\_\_
➢Rapid, shallow breathing
➢Inspiratory rales (crackles)
➢Increased heart rate
➢Distended jugular (neck) veins
➢Peripheral edema
➢Ascites
➢Cyanosis
➢Weight gain
➢Clubbing of fingers
A

Heart Failure

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9
Q 
Symptoms of \_\_\_\_\_\_
➢Fatigue and weakness
➢Orthopnea 
(dyspnea in recumbent position)
➢Exercise intolerance
➢Muscular fatigue
➢Feeling heavy 
(weight gain)
➢GI distress 
(nausea, vomiting & constipation)
A

heart Failure

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10
Q

What are the 2 forms of drugs that are administered for pts with heart failure?

A

ACE inhibitors

Beta blockers

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11
Q

What is used as an intermediate therapy for heart failure?

A

LVAD

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12
Q

Based on study given in class, can dental treatment occur prior to cardiac surgery?

A

Yes

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13
Q

In most cases of HF, the dentist will need to obtain a ________ with the patient’s cardiologist to determine
• The patient’s physical status
• Laboratory test results
• Level of control
• Compliance with medications and recommendations
• Overall stability

A

medical

consultation

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14
Q

Heart failure classification where routine dental care is ok?

A

Class 1

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15
Q

Heart failure classification where routine dental care is likely ok with a med consult?

A

Cllass 2

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16
Q

Heart failure classifications where routine dental should consider to refer to specialized care?

A

3 &4

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17
Q

How should the chair be positioned in a pt with heart failure?

A

Slightly reclined; pt likely can’t handle supine chair position

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18
Q

If patient taking _______
➢Epinephrine should be avoided, if possible
➢Combination increases the risk for arrhythmia

A

digitalis glycoside (digoxin) –positive inotrope

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19
Q

If patient taking digitalis glycoside (digoxin) –positive inotrope
➢Epinephrine should be ________
➢Combination increases the risk for arrhythmia

A

avoided, if possible

20
Q

• Compromised function of the heart valves

A

Valvular disease

21
Q

➢ Do not open properly

A

Valvular Stenosis

22
Q

➢ Do not close properly

➢ Associated with regurgitation

A

Valvular Insufficiency

23
Q

➢ Stiff, sclerosis, stenosis causing either stenosis or insufficency

A

Fibrosis

24
Q

➢ Benign loose CT tumorous changes where valves become Floppy, prolapse, regurgitation
➢ Causes insufficiency

A

Myxomatous degeneration

25
Q 
Signs of \_\_\_\_\_\_:
➢ Murmurs
➢ Syncope
➢ Heart failure
➢ Shortness of breath
A

Valvular disease

26
Q

Symptoms or ______:
➢ Heart failure
➢ Exercise intolerance
➢ Shortness of breath (can also be a symptom)

A

Valvular disease

27
Q

What is the treatment for valvular disease?

A

Surgical

28
Q

Valvular disease/ surgical valves are a predisposition for

A

Infectious endocarditis

29
Q

Most pts on valvular disease are on what types of meds?

A

Blood thiinners

30
Q

If the pt had a mechanical prosthetic valve, what type of meds are they on?

A

Anti clotting

31
Q

If pt has a bioprosthetic valve, what type of meds are they on?

A

Anti-platelet

32
Q

If pt has valvular disease, is a med consult needed?

A

All needed

33
Q

Infection of the inner later of the heart that usually affects cardiac valves
Was almost fatal until the development of peniicillin
15,000 cases diagnosed in US each year

A

infective Endocarditis

34
Q

________:
precipitated by bacterial/ fungal infection; potential death from emboli and valvular disturbance
- Blood turbulence within heart allows causative agent to infect previously damaged valves or other endothelial surfaces

A

Endocarditis

35
Q

_____: caused by bacteremia

- Caused by damaged endothelium affecting blood flow leading to infection

A

Infective endocarditis

36
Q

The following are indications for ______:

  • Mechanical prosthetic heart valve
  • Natural prosthetic heart valve
  • Prior IE
  • Valve repair with prosthetic material
  • Most congenital heart diseases
A

ABX prophylaxis

37
Q

Antibiotic prophylaxis is recommended for
ONLY AT RISK PATIENTS who have
procedures that do what 3 things?

A
  1. Manipulate the gingival tissue
  2. Manipulate the periapex of teeth
  3. Perforate the oral mucosa
38
Q

If the dosage of antibiotic is
inadvertently not administered before the
procedure, the dosage may be administered up
to ______ after the procedure.

A

2 hours

39
Q

What are some of the abx that are used in IE?

A

Amoxicillin
Clindamycin
Ampicillin
Azithromycin

40
Q
  • If a patient is taking a beta-lactam (penicillin, amoxicillin, etc.) for an
    active, existing infection and,
  • If urgent/emergency dental treatment is necessary
    ➢ Prescribe ______ or _______
A

azithromycin or clarithromycin

41
Q

• If dental treatment is elective
➢ Wait ___ days after completion of the antibiotic for their
active infection, then prescribe ______ according to
AHA guidelines

A

10 days; amoxicillin

42
Q

Conditions that do or do not require Antibiotic Prophylaxis
• Heart murmur
• Mitral valve prolapse
• Mitral valve prolapse with regurgitation
• Rheumatic fever
• Stent or coronary artery bypass graft (cabg)

A

DO NOT

43
Q 
Procedures that do or do not require Antibiotic Prophylaxis
• Radiographs
• Placement of appliances
• Routine local injections 
• Tooth shedding or trauma
A

DO NOT

44
Q

_____ or ______ is a predictor of IE chances

A

Size of bacteremia or bacteria number

45
Q

Are most bacteremias caused by dentistry or everyday activities?

A

Everyday activities

Dental Mgmt of Medically Compromised Pts (12 decks)

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