Medically Compromised Pt Flashcards
_______ BP guideline: Less than 120 and Less than 80
Normal
_______ BP guideline: 120-129 and Less than 80
Elevated BP
_______ BP guideline: 130-139 or 80-89
Hypertension (Stage I)
_______ BP guideline: ≥ 140 or ≥ 90
Hypertension (Stage II)
What is the absolute cutoff for bp?
180/110
HTN _____: If BP elevated (can get above 200s systolic and130s diastolic) and patient feels normal →postpone dental treatment
AND go see PCP for evaluation and treatment
HTN urgency
HTN ________:
• END ORGAN DAMAGE!! → GET PATIENT TO EMERGENCY DEPARTMENT NOW!!!!
• Headache, fatigue, blurry vision, numbness, chest pain, dyspnea, anuria
• Higher risk for stroke and uncontrolled bleeding
HTN emergency
_____ hypertension
• Greatest % of hypertensive pts
• > 95% idiopathic
• Primary (essential)
______ hypertension
• 5% with underlying condition: renal/endocrine disorders
• Secondary hypertension
- The following are Risk Factors for _________
* Obesity, Smoking, EtOH, hypercholesterolemia, DM, LVH
hypertension
• Decreased oxygenated blood to myocardium
• Due to narrowing or incomplete blockage of coronary artery(ies)
• NO MYOCARDIAL DAMAGE
• Rx: stent, angioplasty, CABG, meds
• If patient has NO restrictions and NORMAL EKG after above procedure, then patient
can be categorized as ASA II
ISCHEMIC HEART DISEASE
• Symptom of IHD due to discrepancy of myocardial oxygen demand and the ability of the
coronary arteries to supply oxygenated blood
• Causes:
• Narrowing of coronary arteries (LAD a. = “widow-maker”)
• Spasm of coronary arterial wall (Prinzmetals angina)
• Symptoms:
• Chest pain w/ radiation
• Nausea, sweating, dyspnea, HTN
• Bradycardia, Impending sense of doom
ANGINA
\_\_\_\_\_ angina: • Pain on exertion • Infrequent episodes • One nitro tab controls pain • ASA III • Medical Consultation prior to treatment
Stable angina
\_\_\_\_\_ angina: • Pain at rest • Frequent episodes • Increasing nitro for pain relief • ASA IV • Likely requires inpatient care
Unstable angina
What asa is stable angina?
ASA 3
What asa is unstable angina?
ASA 4
- Potent vasodilator: reduces myocardial oxygen demand
- Low doses →VENO-dilator
- High dose →VENO-dilator plus ARTERIO-dilator
- Dosage:
- 0.4 mg metered dose spray (oral/sublingual)
- 0.4 mg/tab, bottle of 25, light protected
- Give every 3-5 min, no more than 3 doses
- Watch the blood pressure!
Nitroglycerin
how long should you generally defer elective procedures after MI?
6 months
• With advent of neovascularization procedures
• If patient has NO restrictions and NORMAL EKG after above procedure, dental work can resume after___
months post MI
2 months
WHAT TO DO FOR EMERGENCIES IN PATIENTS
WITH HISTORY OF ________ :
• Limit Epi (0.04 mg)
• Have Nitro in office and available
• Make certain the patient is taking medications
• More often than should, patients do not take their medications prior to dental treatment
• Monitor blood pressure throughout procedure
• Contact cardiologist that day prior to procedure, if possible
• Reduce anxiety
• Walk patient through procedure
• Reassure constantly
• Change location to hospital setting
HEART ATTACK
\_\_\_\_\_\_\_\_; is the failure of the heart as a basic pump • Symptoms: • Dyspnea • Orthopnea • Paroxysmal nocturnal dyspnea • Weakness/fatigue • Extremity edema
• Congestive heart failure
______ VENTRICULAR FAILURE
• Jugular venous distention (JVD)
• Peripheral edema
• Hepatomegaly
RIGHT Ventricular Failure
__-__ VENTRICULAR FAILURE
• Pulmonary edema
• Dyspnea
• Paroxysmal nocturnal dyspnea
LEFT ventricular failure
(Stroke patient)
• Symptoms < 24 hours
• With return to normal functioning
TRANSIENT ISCHEMIC ATTACK
• TIA
