Module 13 Exam 2 Flashcards
1
Q
In utero when do irregularities in heart develop happen
A
during the first 9 weeks
2
Q
what is the most common heart defects
A
-ventricular septal defect
-patent ductus arteriosus
atrial septal defect
transposition of the great vessels
3
Q
what is a patent ductus arteriosus
A
passageway is open between two great arteries, aorta and pulmonary artery
4
Q
what are preventions for heart defects
A
- rubella vaccine
- no meds used during pregnancy
- appropriate use of x-ray equipment
- control of tobacco, drug and alcohol addictions
5
Q
what are signs and symptoms of a congenital heart disease
A
- easy fatigue
- extertional dyspnea
- cyanosis of lips and nail bed
- poor growth and dev
- heart murmur
- congestive heart failure
6
Q
What are dental hygiene concerns for heart defects
A
- prevention of infective endocardidits
- elimination of oral disease
7
Q
what is the etiology of rheumatic fever
A
group A streptococcual pharyngeal infection
8
Q
what valve is most commonly effected in rheumatic fever
A
mitral valve
9
Q
What is a mitral valve prolapse
A
imperfect closure of the mitral valve between the left atrium and the left ventricle which causes backflow or regurgitation of blood
10
Q
Does mitral valve prolapse have symptoms
A
no
11
Q
is a premed needed for mitral valve prolapse
A
no
12
Q
What is infective endocardidits
A
microbial infection of the heart valves or endocardium that is of concern in the dental and dental hygiene care of high risk patients
13
Q
what is a bacteremia
A
-presence of microorganisms in the blood stream
14
Q
What is infective endocarditis characterized by
A
formation of vegetations composed of masses of bacteria and blood clots on heart valves
15
Q
what bacteria are responsible in most cases for IE
A
streptococci and staphylcocci, alpha-hemolytic strep most prevalent
16
Q
What are risk factors for IE
A
- cardiac abnormalities
- prosthetic heart valves
- history of previous endocarditis
- IV drug abuse
17
Q
What are precipiatating factors of IE
A
- self induced bacteremia
- infection at portals of entry
- trauma to tissues by instrumentation
18
Q
what is a self induced bacteremia
A
activity that can force bacteria through the wall of a diseased sulcus or pocket
19
Q
how do you prevent rheumatic heart disease
A
early diagnosis and tx
20
Q
what are symptoms of rheumatic heart disease
A
- arthritis
- carditis
- low grade fever over several months
- joints, heart muscle, skin, CNS sub q tissues become involved
21
Q
what are practice applications of rheumatic heart disease for the DH
A
-maintenance of high levels of oral health to prevent a need for tx of an advanced disease or caries
22
Q
Rheumatic heart disease is almost always associated with
A
a significant murmur of insufficency
23
Q
what are the symptoms of Mitral Valve prolapse
A
- ususally no symptoms
- palpations, fatigue, atypical chest pain, late systolic murmer
24
Q
How can we prevent IE in the dental setting
A
- review the patient history (consult)
- prophylactic antibiotic premed
- dental hygiene care
25
What can we do with dental hygiene care with a patient who is at risk for IE
- mainetence of high degree of oral health
- instruction of brushing and flossing when under premed
- sequence of tx- bring tissue to healthiest state as possible before instrumentation
- reduce microbial pop around teeth before instrumentation
26
what is hypertension
abnormal elevation of aterial blood pressure
27
what is the etiology of primary hypertension
```
-tobacco use
heredity
overweight
race
salt
sex
age
environment
```
28
what percentage of HTN is primary
95%
29
what is elevated in secondary hypertension
both diastolic and systolic pressures
30
WHat is the etiology of secondary HTN
-oral contraceptive
renal disease
endocrine disorders
medications
31
what is the diastolic bp
pressure exerted by blood within the arteries during resting resistance after contraction of the left ventricle
32
what is systolic bp
pressure exhorted against the aterial walls during ventricular contraction
33
what is normal bp
<80
34
what is prehypertension
120-139 80-89
35
what is stage 1 hypertension
140-159- 90-99
36
what is stage 2 hypertension
>160 >100
37
what are symptoms of hypertension
- high blood pressure
- long standing severe elevation of blood pressure
- major sequela
- malignant hypertension
38
what are symptoms of high blood pressure
```
occipital headaches
dizziness
visual disturbances
weakness
ringing in ears
tingling of hands and feet
```
39
hypertensive crisis is a
life threatening disorder
40
what are results of long standing severe elevation of blood pressure
- mental confusion
- blurring of vision
- severe dyspnea
- chest pains
41
what are symptoms of a major sequela
hypertensive heart disease, enlarged heart with eventual cardiac failure
-hypertensive renal disease
ischemic heart disease
cerebrovascular accident
42
what is treatment goals in primary hypertension
- diastolic below 80
| - lower risk of serious complications, death
43
what are treatment goals in secondary hypertension
-surgical or other correction of cause is needed
44
what are lifestyle changes that must happen in treatment of hypertension
-weight and exercise
diet
tobacco use
other risk factors
45
what is hypertensive heart disease
results from the increased load on the heart because of elevated blood pressure
-to cope with increased work load from the peripherial arterial resistance to the increased flow of blood, muscle fibers are stretched and heart enlarges
46
what is the first effect of hypertension on the heart
thickening of the left ventricle, later the entire heart is enlarged
47
what is ischemic heart disease
the cardiac disability, acute and chronic, that arises from reduction or arrest of blood supply in the myocardium
48
what is the myocardium blood supplied by
coronary artery
49
what does ischemia mean
oxygen deprivation in a local area from a reduced passage of fluid into the area
50
what is ischemic heart disease a result of
an imbalance of the oxygen supply and demand of the myocardium which in turn results from a narrowing or blocking of the lumen of the coronary arteries
51
what is the etiology of ischemic heart diesease
-the principle cause is atherosclerosis of the vessel walls
52
what are risk factors for ischemic heart disease
- inflammation-role in formation of atheromas
- perio microorganisms can cause atheromas
- elevated blood lipids
- increased cholesterol,sat. fat, carbs, alchohol and calories
- tobacco use, diabetes, obesity, sedentary, stress and fam history may all be sig
53
what are manifestations of ischemic heart disease
-angina pectoris
myocardial infarction
congestive heart failure
54
What is angina pectoris
chest pain, the most common symptom of coronary arthrosclerotic heart disease
55
what are the symptoms of angina pectoris
- heavy, squeezing pressure or tightness in mid chest
- pale, faintness, sweating, anxiety, fear difficulty breathing
- pain may radiate down left or right arm, neck
56
what are precipitating factors of angina pectoris
- stable angina
| - unstable angina
57
what is treatment for angina pectoris
-use vasodilator, nitro, supplemental oxygen
58
What are the steps in the procedure during an angina pectoris attack
- terminate tx (call for assistance
- position patient
- administer vasodilator
- check patient response
- call for medical assistance
- record vital signs
- observe recovery
59
What is a myocardial infarction
most extreme manifestation of ishcemic heart disease from a sudden arrest of coronary blood flow
60
what is the etiology of a myocardial infarction
- immediate:thrombosis that blocks an artery narrowed by athrosclerosis
- blockage creates an area of infarction, which leads to necrosis of the area
61
What are the symptoms of an MI
pain, cold sweat, weakness faintness, shortness of breath, nausea, vomiting, BP below baseline
62
Do women always present with symptoms in an MI
no, they pay be nausiated, agitated, diphoretic
63
What is the location and onset of pain in a myocardial infarction
- location; under the sternum, may feel like indigestion, severe pain gives a pressing crushing or heavy sensation
- onset- may be sudden, during sleep or after exercise, pain may be radial
64
How do you manage a MI attack
- terminate tx- sit pt up, give nitro
| - summon medical assistance- when nitro doesnt reduce angina in 3 min prep for BLS
65
What is congestive heart failure
syndrome in which an abnormality of cardiac function is responsible for the inability or failure of the heart to pump blood at a rate necessary to meet the needs of the body tissues
66
what is the etiology of underlying causes of congestive heart failure
- heart valve damage
| - myocardial failure as an abnormality of heart muscle or secondary to ischemia
67
what is the etiology of precipitating causes of congestive heart failure
- acute hypertensive crisis (headache, mental confusion, dizziness, SOB, chest pain)
- massive pulmonary embolism
- aarhythmia
68
what are clinical manifestations of left sided heart failure
- subjective- weakness, fatigue, dyspnea, cough, expectortation, nocturia
- objective-pallor, sweating, cold skin, breathing difficult, heart rate rapid, anxiety fear, diastolic BP increased
69
How should a patient rest in the chair with left sided heart failure
sitting or semi-sitting position
70
what are symptoms of right sided heart failure
-subjective- weakness, fatigue, swelling of feet or ankles, cold hands and feet
objective symptoms- cyanosis of mucous membranes, prominent jug. veins, congestion with edema in organs, anxiety, fear
71
What kind of tx is used in congestive heart failure
-drug therapy, dietary control, limitation of activity
72
what is good to know for the dh in congestive heart failure
-know they may be recieving multiple medical tx
73
What is are basic noninvasive treatments
- counseling
- lifestyle changes
- medications
74
What kinds of surgical treatments may be done?
- coronary dilation
- coronary bypass
- cardiac pacemaker
75
What are the 2 kinds of coronary dilation
- percutaneous transluminal coronary angioplasty (balloon widens lumen)
- coronary stent
76
What is a coronary bypass
-vein graft to jump pass over arteries that have been narrowed
77
What is the natural pacemaker of the heart
SA node in the right atrium
78
what are the two types of cardiac pace makers
demand or fixed rate
79
what can interfere with a cardiac pacemaker
electromagnetic interferences
80
what is important with a cardiac pacemaker in DH care
- be aware of dental devices that have an electric current
81
what are clinical procedures in anticoagulant therapy
- consultation- info about prothrombin time
- treatment planning-pretest within 24 hours for prothombin time, in quadrant scaling and root planing treat the heather quadrant first, least bleeding will occur
Local hemostatic factors (pressure, suture, perio dressing)
82
what are post procedural instructions for anticoagulant therapy
- extraoral icepacks
| - soft diet, cool, gen. moderation of activity
83
What should happen before elective cardiac surgery
pt should be brought to optimum oral health, with all infection removed, all restorations completed
84
what should you do with a patient who is post cardiac surgery
-frequent appointments for maintenance
-prophylactic antibiotic coverage
pts will be on immunosuppressive therapy
