Heart Surgery & Devices Flashcards
what are some common cardiac surgery and devices?
- stents
- CABG
- pacers
- defibrillators
- valves
re-stenosis rate and return of syms of pts who had balloon angioplasty?
w/in 6 mos for 10-50% of pts
re-stenosis rate of pts who had balloon angioplasty with placement of stent?
reduced re-stenosis to 20-30%
types of coronary artery stents
- bare metal
- drug-eluting
- bioresorbable
drug-eluting stent
metal stent coated with a polymer containing anti-proliferative agents that inhibit re-stenosis
which type of stent has an increased risk of thrombosis for 1 year after placement?
drug-eluting stent
should pts w stents placed be given antibiotic prophylaxis?
no but check with cardiologist if recently placed (<1 month)
pts with stents placed are taking what type of drugs?
- Aspirin and clopidogrel
- dual antiplatelet therapy
should pts with stents discontinue taking their aintiplatelet drugs before their dental appt?
no
how long should you wait before treating pt post-stent placement?
at least a month
what is the underlying disease process for CABG?
coronary artery disease
do pts with CABG need antibiotic prophylaxis?
no
pts with CABG are on what type of drugs?
- dual antiplatelet therapy (DAPT)
- aspirin and clopidogrel
should pts with CABG discontinue their medications before their dental appointment?
NO
implantable pacemaker is for what heart condition?
bradycardia
how does an implantable pacemaker work?
if SA node not functioning properly (ie not sending out beat at regular pace) so pacemaker will fill in when SA node falls behind
implantable cardioverter-defibrillator (ICD) is for what heart condition?
ventricular tachycardia
electromagnetic interference of pacemaker or ICD
- detects extraneous signal and misinterprets them
- can cause rate alterations, sensing abnormalities, asynchronous pacing, reprogramming
do pts with implanted cardiac devices need antibiotic prophylaxis?
no
cause of valvular disease
- scarring of myocardial tissues (MI)
- overwork of leaflets (HTN)
- calcium deposits causing thickening of leaflets (age)
- infections (IE)
which valves are most commonly involved in valvular disease?
aortic and mitral valves
prolapse valve
blood coming from atrium to ventricle is getting shoved back into atrium
do aortic valves get prolapsed?
no, they’re not designed like mitral valves
stenosis of valve
- opening narrowed so blood doesn’t exit heart as it should
- leads to heart failure
regurgitation of valves
blood squirting back into atrium
progression of valvular disease
- blood backs up into pulmonary vasculature
- blood backs up in systemic vasculature
- heart failure
diagnosis of valvular disease
- signs/symptoms of heart failure
- cardiac auscultation for murmurs
- detection of murmur will prompt further investigation
echocardiogram
- used for definitive diagnosis of valvular disease
- ultrasound of heart showing size & shape of heart, anatomic abnormalities
- how well chambers and valves are working
treatment of valvular heart disease
- goal=optimize system to keep disease from progressing
- close physician follow-up to catch before it progresses to pulmonary hypertension and heart failure
- valve replacement
mechanical replacement valves
- made of strong, durable materials and last longer than other types of replacement valves
- most will last throughout pt’s entire lifetime
how long do pts with mechanical replacement valves have to take anticoagulant drugs for?
lifetime
how long do pts with mechanical replacement valves have to take antibiotic prophylaxis drugs for?
lifetime
bioprosthetic replacement valves
made from animal valves or other animal tissues that’s strong and flexible
- may last 10-20 years
how long do pts with bioprosthetic replacement valves have to take anticoagulant drugs for?
temporarily (~3 months usually until suture lines are healed)
how long do pts with bioprosthetic replacement valves have to take antibiotic prophylaxis drugs for?
lifetime
normal INR
0.8-1
INR goal for pts with valvular heart disease
2-3
severe valvular disease is considered what type of risk?
major
