Ischemic Heart Disease and Heart Failure Flashcards
what is ischemic heart disease ?
reduced blood supply to heart muscle from coronary arteries
what is the main cause of IHD ?
atheroma
what is the definition of ischemia ?
reduced blood supply to a tissue leading to reduced supply of oxygen and glucose
What is the definition of infarction ?
Tissue death due to ischemia
What is coronary artery disease ?
Obstruction of coronary blood flow
What are the causes of coronary artery disease ?
Atheroma, thrombosis, vasospasm, embolus, IE, tumour
What is atherosclerosis ?
Pathological, focal, symmetric narrowing of the arterial lumen due to atheromatous plaque build up
How does atherosclerosis progress ?
LDLs accumulate and oxidise, macrophages phagocytose oxidised LDL and form foam cells, necrosis, cell debris and for,action of cholesterol core, fibrous cap formation, fatty streak increases, fibrous plaque of cholesterol rich lipid core and smooth muscle proliferation, acute event - thromboembolism or plaque rupture
What are the risk factors for ischemic heart disease ?
Smoking, high bp, diet and cholesterol, diabetes, family history
What is the spectrum of IHD classified into ?
Stable angina.
Acute coronary syndromes - unstable angina and MI
What are the clinical symptoms of stable angina ?
Central crushing chest pain, pallor, sweating, nausea, vomiting, palpitations, induced by exercise, relieved by GTN
What are the clinical symptoms of acute coronary syndromes ?
Onset of pain at rest, not relieved by GTN, lasting over 30 minutes, impending sense of doom, sudden cardiac arrest
What is the pathogenesis of ACS ?
Fibrous cap of atheromatous plaque ruptures, platelet activation and thrombosis, some platelet activation and vasospasm, ischemia of myocardium (unstable angina), infarction of myocardium (NSTEMI, STEMI)
How is IHD diagnosed ?
ECG, troponin, angiography, myocardial perfusion study, stress echo, exercise treadmill test, CT calcium scoring
What is angioplasty ?
Stenting
What is the management for acute ACS ?
Oxygen, GTN, morphine, anti emetics, anti platelets, factor Xa inhibitors
How is cardiovascular disease prevented in patients with IHD ?
Risk factor modification, aspirin, statin, ACEi, anti anginal
What is the relevance of IHD to dentistry ?
Avoid GA or sedation, LA with adrenaline problematic if given iv
What drug interactions are relevant to IHD and dentistry ?
Statins and erythromycin or fluconazole may increase risk of statin related myopathy
What is heart failure ?
The heart fails to maintain adequate circulation to meet demands of the body despite adequate venous filling pressure
What is the term for heart failure involving both sides of the heart ?
Congestive cardiac failure
What are the causes of heart failure ?
Pump failure - IHD, cardiomyopathy, arrhythmias, IE.
Excessive afterload - hypertension, aortic stenosis.
Excessive preload - renal failure, mitral regurgitation, iv fluids.
Restriction - pericarditis, cardiac tamponade.
High output failure - severe anaemia, hyperthyroidism, pregnancy, hypoxia, pagets
What are the symptoms of left sided heart failure ?
Pulmonary oedema causing breathlessness, coughing, orthopnea, reduced exercise tolerance.
Reduced organ perfusion causing low concentration, tiredness, confusion, fatigue, reduced kidney function, muscle wasting and weight loss
What are the symptoms of right sided heart failure ?
Peripheral oedema causing ankle swelling.
Ascites.
Hepatomegaly.
Increased JVP
What investigations are made in heart failure ?
Chest X Ray showing pulmonary congestion with bilateral pleural effusions and cardiomegaly.
Plasma brain natriuretic peptide.
ECG may show LV hypertrophy.
Echocardiogram to check for structural abnormalities and the ejection fraction
What is the management for heart failure ?
Diuretics, ACEi, beta blockers, digoxin, spironolactone
What is the relevance of heart failure to dentistry ?
Orthopnea, caution with NSAIDs as react with ACEi, digoxin interacts with macrolides, postural hypotension if taking diuretics
