Medical Conditions Flashcards
🔸Inability of myocardium to pump enough blood
🔸Lungs/and or circulatory system become congested
Congestive heart failure
Stress in congestive heart failure should be avoided due to
🔸Increase workload of heart surpassing functional ability
🔸Pulmonary Oedema
Congestive heart failure symptoms
🔸Extreme dyspnoea
🔸Hyperventilation
🔸Cough
🔸Hemoptysis(pinkish foam expectoration)
🔸Difficulty breathing
Preferred patient position in congestive heart failure
Sitting position
Management of congestive heart failure
🔸Consultation with cardiologist
🔸 Oral premedication, e.g., 5–10 mg diazepam (Valium) or 1.5–3 mg bromazepam (Lexotanil), 1 h be-
fore procedure
🔸Small amount of vasoconstrictor
🔸Short appointments as painless as possible
Temporary ischemia in Myocardium, resulting in diminished oxygen
Angina Pectoris
Symptoms of angina
🔸 Brief paroxysmal pain posterior to the sternum
🔸 Burning sensation, pressure, or tightness
🔸 Pain radiating to the left shoulder, neck, left arm (with a numb sensation as well as tingling), sometimes down the chin and teeth of the mandible (usually the left side)
🔸Pain sometimes felt in epigastrium, causing confusion in diagnosis
🔸Perspiration
🔸Extreme anxiety
These patients have an increased risk of angina pectoris symptoms in dental surgery
Coronary heart disease history
Episode of angina pectoris precipitated by
🔸Fatugue
🔸Stress
🔸Rich meal
Symptoms of Angina Pectoris subside after
🔸2-5 minutes of rest
🔸Administering of vasodilator
Treatment of Angina pectoris
🔸Consultation with cardiologist
🔸 5–10 mg diazepam (Valium) or 1.5–3 mg bromazepam (Lexotanil) orally, 1 h before the surgical procedure
🔸Carrying out procedure in hospital
🔸Small amounts of vasoconstrictor in LA
🔸Short appointments
Ischemic necrosis of an area of the heart due to complete blocking of branches of the coronary arteries
Myocardial infarction
Myocardial infarction symptoms
🔸 Sudden onset with severe pain posterior to the sternum, which increases in severity rapidly
🔸 w/ burning sensation, pressure, and extreme tightness
🔸 More severe compared to angina pectoris, lasts longer than 15 min and does not subside with rest or use of nitrates sublingually
🔸 Radiates to the left shoulder, neck region, mandible, teeth, midback region, epigastrium, and right arm
🔸 Nausea, vomiting, perspiration, and dyspnea
Management of myocardial infarction
🔸 Avoid routine dental surgery on patients with recent infarctions (within the last 6 months)
🔸 if treatment necessary (acute infection, pain, etc.), management should take place in a hospital
🔸Six months following the myocardial infarction, patients may also be treated in the dental office- follow same precautions as Angina pectoris
Damage of the mitral and aortic valves, which may be described as stenosis, or insufficiency
Rheumatic heart disease
May develop after invasive surgical procedures and is dangerous for patients with rheumatic fever
Transient bacteraemia
Management of Rheumatic heart disease
🔸Antibiotic treatment prior to surgery
🔸Avoidance of vasoconstrictors/ maximum concentration of 1:100,000
Importance of antibiotics in Rheumatic heart disease
Transient bacteraemia after surgical procedures can affect endocardium resulting in endocarditis
Pathologic sounds due to vibrations caused by turbulence in the circulation through the vessels or chambers of the heart
Murmurs
Heart murmurs are caused by
🔸Valve defects, resulting from rheumatic disease
🔸Septic endocarditis
🔸Syphilis
🔸Congenital heart conditions
Types of murmurs
🔸Systolic
🔸Diastolic
🔸Continuous
🔸Innocent/functional- good prognosis
Management of Murmurs
🔸Establish whether murmur is functional or pathologic
🔸Antibiotic prophylaxis
Types of congenital heart disease
🔸Patent ductus arteriosus
🔸Atrial septal defects
🔸Ventricular septal defects
🔸Idiopathic pulmonary stenosis
🔸Stenosis of pulmonary or aortic valve
Management of main congenital heart diseases
🔸Consultation with physician
🔸Premedication before treatment
🔸Antibiotic prophylaxis especially in Rheumatic heart Disease
🔸Limited vasoconstrictor use
🔸Short appointments
Periodic variation in rhythm of heart caused by disturbances in the excitability of the ventricles by sinoatrial node
Arrhythmia
Management of Arrhythmia
🔸Consultation with doctor
🔸In severe cases avoidance of LA containing vasoconstrictors/ postponing treatment
🔸Premedication before surgical procedure
🔸short appointments and pain control
Management of prosthetic heart values
🔸Antibiotic prophylaxis before surgical procedure
🔸Same as valve disease of rheumatic origin
Why antibiotic prophylaxis needed in patients with prosthetic heart valves
Endocardium associated with the artificial valve is particularly susceptible to microbial infection
Used for the control of symptoms due to disturbances of the cardiac rhythm
Cardiac pacemakers
Management of patients with pacemakers
🔸 The use of certain dental instruments increases the risk of abnormal activity of the pacemaker (mono-polar electrosurgery, ultrasonic scalers, electronic dental anesthesia, etc.)
🔸 Local anesthetics with vasoconstrictors may be used safely
🔸 Antibiotic prophylaxis not required
Normal arterial pressure in an adult
-Under 140/90
-Hypertension is abnormal elevation of systolic and diastolic pressure over those values
Arterial hypertension of unknown etiology that exists in 95% of cases is named
Essential hypertension
Arterial hypertension where in 5% of cases, the cause is known is called
Secondary hypertension
High blood pressure values where treatment can be carried out
140–160/90–95 mmHg
High blood pressure values where premedication is required
🔸160–190/95–110 mmHg
🔸30mins to 1 hour before treatment
If the blood pressure values remain high even after premedication (e.g., over 180/110 mmHg)
the dental session is postponed and the patient is referred to his/her physician for further treatment
Blood pressure values where patients not allowed regular dental treatment
🔸190/110 mmHg
🔸Treated in hospital