SC- Cardiology

Question 1

Compare the two types of congential cardiac defects.

Answer 1

Cyanotic - deoxygenated blood or a mix of oxygenated and deoxygenated blood in circulation. (e.g. fallot tetralogy)

Acyanotic- there is a shift of blood from the left to the right side of the heart through a structural defect. (e.g. patent ductus arteriosis)

Question 2

What are the dental considerations of congential heart defects?

Answer 2

• Bleeding risk- patient will be on anticoagulants
• Risk of infective endocarditis (bacteraemia’s are generated during treatment)
• Risk of general anaesthetic
• Patient needs to be dentally fit- active disease will delay the surgery.
• If the patient has had previous infective endocarditis.

Question 3

How do we treat a patient with a congentinal heart defect.

Answer 3

• Make the patient dentally fit
• High risk prevention (to maintain good oral health)
• Treat under sedation.

Question 4

Where is a paediatric patient listed for cardiac surgery treated?

Answer 4

By the specialist paediatric department.

Question 5

What is infective endocarditis and list some clinical features?

Answer 5

This is an infection of the endocardium (e.g. valves)

Fever

Murmour

Fatigue

Nail bed haemorrhages

Question 6

What causes infective endocarditis?

Answer 6

The introduction of oral streptococci into the bloodstream through:

Poor oral hygiene

Invasive Denal treatments (those manupulating the dento-gingival junction, the periapical region or perforation of the oral mucosa)

Question 7

What cardiac patients do we treat routinely and why?

Answer 7

Patients with acquired valvular heart disease (stenosis or regurgitation)

Hypertrophic cardiomyopathy (Enlarged heart muscle)

Antibiotic prophylaxis is not recommended.

But we need to warn the patients there is a small risk of infective endocarditis (but the risk of antibiotic resistance is greater) , provide the patients with the symptoms of IE & discuss the importance of maintaining good oral health.

Question 8

What patients do we consider antibiotic prophylaxis for.

Answer 8

• Valve replacements
• Patients who have previously had infective endocarditis.
• Structural congential heart diseases:
  
  • Any cyanotic CHD.
  • If the CHD has been repaired within 6 months.
  • If the CHD has been repaired using a residual shunt.
  • If the valvular regurgitation remains after repairing the CHD.

Question 9

What antibiotic do we use for prophylaxis?

Answer 9

Amoxicillin -3g 60 minutes before procedure

50mg/kg for children.

Clindamycin (for those allergic to penicillin)

600mg 60 minutes before procedure.

20mg/kg for children.

Question 10

Discuss making a patient dentally fit.

Answer 10

This is crucial before valve surgery.

Any possible infections should be extracted or treated (e.g. caries/ gingivitis/ periodontal disease/ abcesses)

Hall crowns and pulp treatments are contra-indicated.