Heart Failure, Infective Endocarditis, and Valvular diseases Flashcards
Which ventricle of the heart typically fails first?
Left Vent
How is the size of heart and effectiveness of the heart changed in heart failure?
Increase in size with decrease in effectiveness
_____ can measure the degree of heart failure
-Measures amount (%) of blood that leaves the left ventricle after contraction
Ejection Fraction
What is the Ejection Fraction (%) range that is considered normal?
55-70%
How is ejection fraction calculated?
[Blood volume pumped out/ blood volume in chamber] x 100
If the ejection fraction is between 41-49%, what does it say about extent of heart failure?
Borderline HF: warning signs
If EF is less than ___%, it signifies that HF is likely
Less than 40%
Signs of \_\_\_\_\_\_\_ ➢Rapid, shallow breathing ➢Inspiratory rales (crackles) ➢Increased heart rate ➢Distended jugular (neck) veins ➢Peripheral edema ➢Ascites ➢Cyanosis ➢Weight gain ➢Clubbing of fingers
Heart Failure
Symptoms of \_\_\_\_\_\_ ➢Fatigue and weakness ➢Orthopnea (dyspnea in recumbent position) ➢Exercise intolerance ➢Muscular fatigue ➢Feeling heavy (weight gain) ➢GI distress (nausea, vomiting & constipation)
heart Failure
What are the 2 forms of drugs that are administered for pts with heart failure?
ACE inhibitors
Beta blockers
What is used as an intermediate therapy for heart failure?
LVAD
Based on study given in class, can dental treatment occur prior to cardiac surgery?
Yes
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
medical
consultation
Heart failure classification where routine dental care is ok?
Class 1
Heart failure classification where routine dental care is likely ok with a med consult?
Cllass 2
Heart failure classifications where routine dental should consider to refer to specialized care?
3 &4
How should the chair be positioned in a pt with heart failure?
Slightly reclined; pt likely can’t handle supine chair position
If patient taking _______
➢Epinephrine should be avoided, if possible
➢Combination increases the risk for arrhythmia
digitalis glycoside (digoxin) –positive inotrope
If patient taking digitalis glycoside (digoxin) –positive inotrope
➢Epinephrine should be ________
➢Combination increases the risk for arrhythmia
avoided, if possible
• Compromised function of the heart valves
Valvular disease
➢ Do not open properly
Valvular Stenosis
➢ Do not close properly
➢ Associated with regurgitation
Valvular Insufficiency
➢ Stiff, sclerosis, stenosis causing either stenosis or insufficency
Fibrosis
➢ Benign loose CT tumorous changes where valves become Floppy, prolapse, regurgitation
➢ Causes insufficiency
Myxomatous degeneration
Signs of \_\_\_\_\_\_: ➢ Murmurs ➢ Syncope ➢ Heart failure ➢ Shortness of breath
Valvular disease
Symptoms or ______:
➢ Heart failure
➢ Exercise intolerance
➢ Shortness of breath (can also be a symptom)
Valvular disease
What is the treatment for valvular disease?
Surgical
Valvular disease/ surgical valves are a predisposition for
Infectious endocarditis
Most pts on valvular disease are on what types of meds?
Blood thiinners
If the pt had a mechanical prosthetic valve, what type of meds are they on?
Anti clotting
If pt has a bioprosthetic valve, what type of meds are they on?
Anti-platelet
If pt has valvular disease, is a med consult needed?
All needed
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
infective Endocarditis
________:
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
Endocarditis
_____: caused by bacteremia
- Caused by damaged endothelium affecting blood flow leading to infection
Infective endocarditis
The following are indications for ______:
- Mechanical prosthetic heart valve
- Natural prosthetic heart valve
- Prior IE
- Valve repair with prosthetic material
- Most congenital heart diseases
ABX prophylaxis
Antibiotic prophylaxis is recommended for
ONLY AT RISK PATIENTS who have
procedures that do what 3 things?
- Manipulate the gingival tissue
- Manipulate the periapex of teeth
- Perforate the oral mucosa
If the dosage of antibiotic is
inadvertently not administered before the
procedure, the dosage may be administered up
to ______ after the procedure.
2 hours
What are some of the abx that are used in IE?
Amoxicillin
Clindamycin
Ampicillin
Azithromycin
- 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 _______
azithromycin or clarithromycin
• If dental treatment is elective
➢ Wait ___ days after completion of the antibiotic for their
active infection, then prescribe ______ according to
AHA guidelines
10 days; amoxicillin
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)
DO NOT
Procedures that do or do not require Antibiotic Prophylaxis • Radiographs • Placement of appliances • Routine local injections • Tooth shedding or trauma
DO NOT
_____ or ______ is a predictor of IE chances
Size of bacteremia or bacteria number
Are most bacteremias caused by dentistry or everyday activities?
Everyday activities
