PATIENT MANAGEMENT- HEART DISEASES

Question 1

1. Cleft lip & palate / Ventricular Septal Defect (Formative, 2005)
   a. What will the patient’s medical history affect your dental management of the patient?

Answer 1

• Antibiotic prophylaxis for CHD
• Cleft lip & palate—
  
  • speech problem, communication problem
  • malaligned teeth –> OHI
  • teeth number –> impaction or missing –> extraction, ortho, prosthetic, implant

Question 2

1. Cleft lip & palate / Ventricular Septal Defect
   b. What LA would you use (name , concentration), and state its components

Answer 2

 Xylestein –A, 2% lignocaine with 1:80000 epinephrine, Ringer’s solution, preservatives, reducing agent

Question 3

2. What are the clinical management and precautions for patients with rheumatic heart disease?

Answer 3

• According to AHA 2007 guideline, RHD is no longer considered as high risk for IE, which do not need antibiotic cover prior to dent al treatment
• Clinical management
  
  • Treatment of RHD involves pharmacological therapy like aspirin and antibiotics
  • Caution possible drug interactions
  • Reasonable to defer elective dental treatments if patient is under active medical treatment, until after consultation with physician

Question 4

3. Patient with mitral valve regurgitation and history of MI (Summative, 2007) a. Risks & precautions to be taken for management of this patient (5)

Answer 4

Question 5

3. Patient with mitral valve regurgitation and history of MI (Summative, 2007)
   b. How could dental extraction lead to IE? Common oral micro-organisms involved (10)

Answer 5

Question 6

3. Patient with mitral valve regurgitation and history of MI (Summative, 2007)
   c. Signs and symptoms of MI and investigations to be taken (5)

Answer 6

• Palpitation, shortness of breath , angina pectoris, fatigue, dizziness, nausea, vomiting, loss of consciousness, swollen feet and ankles
• Diagnostic tests: Electrocardiogram, blood pressure measurement, blood cholesterol level, angiogram( contrast medium with chest radiograph)

Question 7

3. Patient with mitral valve regurgitation and history of MI (Summative, 2007)
   d. American heart association guideline on IE (5)

Answer 7