Management of the cardiac patient Flashcards
In hypertension what stage usually has no contraindication to ambulatory oral surgery?
-Mild to moderate
What is the systolic and diastolic range in mild to moderate hypertension?
- Systolic < 200
- Diastolic < 110
What is the systolic and diastolic range in severe hypertension?
- Systolic > 200
- Diastolic > 110
What do you do if someone has severe hypertension
-Postpone until pressure is better controlled
If someone is in mild to moderate hypertension what should you do with treatment?
-You can do treatment
If someone has an acute hypertensive event with SYMPTOMS what is that known as?
-Hypertensive emergency
What are some symptoms with a hypertensive emergency?
- Dizzy
- Faint
What are the key principles with Ischemic heart disease?
- Mismatch in myocardial oxygen demand and oxygen supply
- Angina is a symptom of ischemic heart disease
Who does Ischemic heart disease occur in?
- Men over 40
- Post menopausal women
What drug do you give if someone has angina?
-Nitroglycerin
What does nitroglycerin do?
- Venodilation (more than vasodilation)
- Vasodilation
- Decreases the demand on the heart because it diminishes the preload
How many carpules can you give at most to a patient with angina?
-2 carps every 30 minutes
What is what Metabolic equivalent defined as?
-3.5 mL O2 uptake/kg per min
If a person answers yes to getting chest pain after walking one city block or a flight of stairs what does that mean?
-They have poor functional capacity
What is the line of MET’s for poor function capacity?
< 4 MET
What is a Myocardial infarction?
-Results when an oxygen supply-demand mismatch results in myocardial cell/death/ dysfunction
What is the difference between angina and myocardial infarction?
-Myocardial infarction is associated with cell death
If a person has a myocardial infarction history how long should it be until dental treatment elective surgeries are performed?
6 months
Dual antiplatelet therapy is recommended for how long following PCI (Percutaneous intervention) and stenting procedures?
-12 months
What drugs are they one if doing DAPT?
- Aspirin (platelets)
- Plavix (platelets)
- Coumadin (vitamin K dependent)
- Xabans
What is common in patients with history of ischemic heart disease?
-Cardiac Dysrhythmias
What is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body’s needs known as?
-Heart Failure
What are some of they symptoms of congestive heart failure?
- Shortness of breath (due to fluid build up in the lungs)
- Coughing
What should you do if someone has congestive heart failure?
-Defer treatment until heart function has been medically improved an the physician believes treatment is possible
What are Cerebrovascular accidents?
-Strokes
What are the two types of strokes?
- Hemorrhagic
- Ischemic
Which type of stroke deals with a clogged artery?
-Ischemic
If a patient has had a Cerebrovascular accident (CVA) what are they at further risk for?
-More CVAs
If a person has had a CVA and you take their blood pressure and it appears hypertensive what should you do?
-Defer treatment
What is infective endocardititis?
-An infection of the heart chambers or valves
What bacteria is a common cause of IE?
-Streptococcus viridans
What are the four guidelines if someone has IE that need a prophylaxis treatment?
- Prothetic cardiac valve
- Previous IE
- Congenital Heart Disease
- Cardiac transplant
What is the most common antibiotic for IE prophylaxis?
-Amoxicillin
If a person is allergic to penicillin what antibiotic should you use for IE prophylaxis?
-Clindamycin
What amount of amoxicillin should you provide to someone who has IE?
- 2 g 30-60 minutes prior to procedure (adults)
- 50 mg/kg in children
What amount of clindamycin should you provide to someone who has IE?
- 600 mg (adults)
- 20 mg/kg
If patients have a mechanical valve are they anti-coagulated? If so for how long?
-Yes and for life
What are the four Vitamin K dependent factors?
- II
- VII
- IX
- X
What is a normal INR (International normalized ratio)?
1
What do you need to know if somebody is on coumadin?
-INR #
What is another name for Coumadin?
-Warfarin
MONA stands for what? Use this for someone who begins having severe chest pain
- Morphine
- Oxygen
- Nitroglyercine (sublingual)
- Aspirin