Module 13 Exam 2 Flashcards
In utero when do irregularities in heart develop happen
during the first 9 weeks
what is the most common heart defects
-ventricular septal defect
-patent ductus arteriosus
atrial septal defect
transposition of the great vessels
what is a patent ductus arteriosus
passageway is open between two great arteries, aorta and pulmonary artery
what are preventions for heart defects
- rubella vaccine
- no meds used during pregnancy
- appropriate use of x-ray equipment
- control of tobacco, drug and alcohol addictions
what are signs and symptoms of a congenital heart disease
- easy fatigue
- extertional dyspnea
- cyanosis of lips and nail bed
- poor growth and dev
- heart murmur
- congestive heart failure
What are dental hygiene concerns for heart defects
- prevention of infective endocardidits
- elimination of oral disease
what is the etiology of rheumatic fever
group A streptococcual pharyngeal infection
what valve is most commonly effected in rheumatic fever
mitral valve
What is a mitral valve prolapse
imperfect closure of the mitral valve between the left atrium and the left ventricle which causes backflow or regurgitation of blood
Does mitral valve prolapse have symptoms
no
is a premed needed for mitral valve prolapse
no
What is infective endocardidits
microbial infection of the heart valves or endocardium that is of concern in the dental and dental hygiene care of high risk patients
what is a bacteremia
-presence of microorganisms in the blood stream
What is infective endocarditis characterized by
formation of vegetations composed of masses of bacteria and blood clots on heart valves
what bacteria are responsible in most cases for IE
streptococci and staphylcocci, alpha-hemolytic strep most prevalent
What are risk factors for IE
- cardiac abnormalities
- prosthetic heart valves
- history of previous endocarditis
- IV drug abuse
What are precipiatating factors of IE
- self induced bacteremia
- infection at portals of entry
- trauma to tissues by instrumentation
what is a self induced bacteremia
activity that can force bacteria through the wall of a diseased sulcus or pocket
how do you prevent rheumatic heart disease
early diagnosis and tx
what are symptoms of rheumatic heart disease
- arthritis
- carditis
- low grade fever over several months
- joints, heart muscle, skin, CNS sub q tissues become involved
what are practice applications of rheumatic heart disease for the DH
-maintenance of high levels of oral health to prevent a need for tx of an advanced disease or caries
Rheumatic heart disease is almost always associated with
a significant murmur of insufficency
what are the symptoms of Mitral Valve prolapse
- ususally no symptoms
- palpations, fatigue, atypical chest pain, late systolic murmer
How can we prevent IE in the dental setting
- review the patient history (consult)
- prophylactic antibiotic premed
- dental hygiene care
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
what is hypertension
abnormal elevation of aterial blood pressure
what is the etiology of primary hypertension
-tobacco use heredity overweight race salt sex age environment
what percentage of HTN is primary
95%
what is elevated in secondary hypertension
both diastolic and systolic pressures
WHat is the etiology of secondary HTN
-oral contraceptive
renal disease
endocrine disorders
medications
what is the diastolic bp
pressure exerted by blood within the arteries during resting resistance after contraction of the left ventricle
what is systolic bp
pressure exhorted against the aterial walls during ventricular contraction
what is normal bp
<80
what is prehypertension
120-139 80-89
what is stage 1 hypertension
140-159- 90-99
what is stage 2 hypertension
> 160 >100
what are symptoms of hypertension
- high blood pressure
- long standing severe elevation of blood pressure
- major sequela
- malignant hypertension
what are symptoms of high blood pressure
occipital headaches dizziness visual disturbances weakness ringing in ears tingling of hands and feet
hypertensive crisis is a
life threatening disorder
what are results of long standing severe elevation of blood pressure
- mental confusion
- blurring of vision
- severe dyspnea
- chest pains
what are symptoms of a major sequela
hypertensive heart disease, enlarged heart with eventual cardiac failure
-hypertensive renal disease
ischemic heart disease
cerebrovascular accident
what is treatment goals in primary hypertension
- diastolic below 80
- lower risk of serious complications, death
what are treatment goals in secondary hypertension
-surgical or other correction of cause is needed
what are lifestyle changes that must happen in treatment of hypertension
-weight and exercise
diet
tobacco use
other risk factors
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
what is the first effect of hypertension on the heart
thickening of the left ventricle, later the entire heart is enlarged
what is ischemic heart disease
the cardiac disability, acute and chronic, that arises from reduction or arrest of blood supply in the myocardium
what is the myocardium blood supplied by
coronary artery
what does ischemia mean
oxygen deprivation in a local area from a reduced passage of fluid into the area
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
what is the etiology of ischemic heart diesease
-the principle cause is atherosclerosis of the vessel walls
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
what are manifestations of ischemic heart disease
-angina pectoris
myocardial infarction
congestive heart failure
What is angina pectoris
chest pain, the most common symptom of coronary arthrosclerotic heart disease
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
what are precipitating factors of angina pectoris
- stable angina
- unstable angina
what is treatment for angina pectoris
-use vasodilator, nitro, supplemental oxygen
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
What is a myocardial infarction
most extreme manifestation of ishcemic heart disease from a sudden arrest of coronary blood flow
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
What are the symptoms of an MI
pain, cold sweat, weakness faintness, shortness of breath, nausea, vomiting, BP below baseline
Do women always present with symptoms in an MI
no, they pay be nausiated, agitated, diphoretic
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
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
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
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
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
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
How should a patient rest in the chair with left sided heart failure
sitting or semi-sitting position
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
What kind of tx is used in congestive heart failure
-drug therapy, dietary control, limitation of activity
what is good to know for the dh in congestive heart failure
-know they may be recieving multiple medical tx
What is are basic noninvasive treatments
- counseling
- lifestyle changes
- medications
What kinds of surgical treatments may be done?
- coronary dilation
- coronary bypass
- cardiac pacemaker
What are the 2 kinds of coronary dilation
- percutaneous transluminal coronary angioplasty (balloon widens lumen)
- coronary stent
What is a coronary bypass
-vein graft to jump pass over arteries that have been narrowed
What is the natural pacemaker of the heart
SA node in the right atrium
what are the two types of cardiac pace makers
demand or fixed rate
what can interfere with a cardiac pacemaker
electromagnetic interferences
what is important with a cardiac pacemaker in DH care
- be aware of dental devices that have an electric current
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)
what are post procedural instructions for anticoagulant therapy
- extraoral icepacks
- soft diet, cool, gen. moderation of activity
What should happen before elective cardiac surgery
pt should be brought to optimum oral health, with all infection removed, all restorations completed
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
