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BDS2 - Cardiovascular > valve disease > Flashcards

valve disease Flashcards

1
Q

how many valves are there

A

= 4

  • 2 left
  • 2 right
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2
Q

name the 2 valves on the left

A

aortic

mitral

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3
Q

are the valve on the left working under high or low pressure

A

high pressure

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4
Q

name 2 valves on the right

A

pulmonary

tricuspid

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5
Q

which side of the heart do valves most commonly fail

A

left

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6
Q

what are the reasons for the valves on the left side of the heart failing

A
  • aortic stenosis and incompetence

- mitral stenosis and incompetence

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7
Q

define stenosis

A

narrowed valves so they restrict blood flow out

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8
Q

define incompetence

A

firing lots of blood out of the chamber but then not closing properly so half the blood will run back into the same chamber again

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9
Q

what will treat valve failure

A

prosthetic valves
it is better to treat the valve problem before the patient develops permanent heart problems
patient should be healthy once the valve is replaced

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10
Q

what are cardiac valves

A

cusplets of collagen tied onto muscle wall of heart

fibres connect valve cusplets onto papillary muscle to keep it under tension

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11
Q

where is the mitral valve

A

between left atrium and left ventricle

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12
Q

what happens in mitral stenosis

A

the mitral valve won’t open fully / properly
then there is a build up of pressure in the atrium
and reduced blood flow to the ventricle
higher pressure in the pulmonary system as the lungs can’t empty the blood out as well as the blood isn’t leaving the left atrium as it should

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13
Q

what are the symptoms of valve problems

A

rarely any
usually undiagonosed
valve failure is common in elderly so if the activity levels are low anyway then the patient won’t know the problems
easier to notice valve problems in younger people as they will be breathless with exertion and be tired all time

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14
Q

what is rheumatic heart disease

A

reaction to infection
antibody targets heart valve tissues
damage caused by immune system

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15
Q

how do valve problems affect dental practise

A
  • normal valves not functioning properly has no affect

- prosthetic valve replacements fully functioning are worrying for some dental treatment

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16
Q

what are the causes of valve disease

A
  • congenital abnormality
    > bicuspid aortic valve (valve formed incorrectly during development - usually the reason for valve replacement in young people)
  • myocardial infarction
    > papillary muscle rupture
  • rheumatic fever
    > immunological reaction to streptococci
  • dilation of the aortic root
    > syphillis
    > aneurysm
    > problems at aorta
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17
Q

what is the new method of investigating valve disease

A

ultrasound
shows the heart moving in real time so you can see the valves opening and closing and see the heart muscle contracting

can show the movement of the blood and can identify if it is flowing the correct way or not
called the doppler flow assessment / ultrasound

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18
Q

what are the 2 types of valve replacements

A
  • mechanical

- prosthetic / pig valve

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19
Q

what are the advantages and disadvantages of mechanical valves

A

advantage
- gives longest benefit

disadvantage

  • blood will clot on that valve and cause problems
  • patient must be on anticoagulants for life (consider this when planning extractions etc)
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20
Q

what is endocarditis

A

infection of the heart muscle layer (endocardium)

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21
Q

how can dentistry prevent endocarditis

A
  • bacteria in the mouth (strep) causes endocarditis
  • maximise patient’s oral health
  • sometimes antiobiotics are given, take this case by case
    idea is that you kill bacteria in the blood stream before they Have the chance to cause problems in the heart
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22
Q

what are the advantages and disadvantages of prosthetic valves

A

advantage

  • right size for a human valve
  • has got natural valve leaflets (collagen leaflets)
  • blood wont stick to this
  • no need for anticoagulants
  • useful for elderly so they dont need to take medication

disadvantage

  • not long lasting
  • will only last 10 years before the valve problems return
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23
Q

what sort of valve would you give to children

A
  • pig valve
    dont need to be on anticoagulants
    children always fall and bleed so there is less complications
    will get a mechanical valve wen they are older
24
Q

what happens to the heart during valve replacement surgery

A

has to be stopped to replace the valve
tubes going to a heart bypass machine so it takes the blood to a pump then pumps it back into the body
after replacement need to restart the heart then disconnect bypass machine
always a risk the heart wont start again

25
Q

what do patient’s often dislike about a mechanical valve

A

when the valve opens and shits it makes a noise

can hear patients heart rate speed up when anxious

26
Q

when do congenital heart defects occur

A

as you are forming as an embryo

failures in normal development and fusion of the embryonic heart

27
Q

what are the different types of congenital heart defects

A

> atrial septal defects
ventricular septal defects
patent ductus arteriosus
great vessel malformations

28
Q

what is patent ductus arteriosis

A

an unclosed hole in the heart
before a baby is born the blood does not need to go into the lungs to get oxygenated so the ductus arteriosus is a hole that allows the heart to bypass th lungs
when baby is born they need to get oxygen from the lungs so the hole is supposed to close
if the hole doesnt close then a necessary step of circulation is skipped

29
Q

why is ventricular septal defects a bigger problem than atrial septal defects

A

big difference between pressure in the left and right ventricles whereas the pressure is usually similar between left and right atrium

the left ventricle squirts blood into right ventricle so the blood has to go through the lungs again and it increases the work load of the heart
can lead to right side heart failure

30
Q

what is cyanosis

A

central cyanosis is a problem of congenital heart disease
need oxygenated blood to survive
the right ventricle pumps blood into the aorta so the blood remains deoxygenated
affects core tissues

peripheral cyanosis is caused by a cold environment
circulation to peripheral tissues shuts down so people go blue

cyanosis exists when there is 5g/dl or more of deoxygenated Hb in the blood

31
Q

what happens in an atrial septal defect

A

the left atrium contacts and send oxygenated blood into the right atrium which then sends it around the lungs again
not a problem as long as the volume of blood is low

32
Q

what happens in ventricle septal defects

A

blood moves from left ventricle to right ventricle
means oxygenated blood goes back around the lungs again
left ventricle has to do more work to maintain the cardiac output of the heart
often leads to heart failure

33
Q

what is co-arctation of the aorta also called

A

aortic narrowing

34
Q

what is co-arctation of the aorta

A

condition present at birth
ductus arteriosus closes but causes the aorta to narrow
difficult to pump blood through the rest of the body and the rest of the heart has to work harder to pump blood through the narrowed aorta and the blood pressure increases in the left ventricle
can be mild
may eventually lead to heart failure

35
Q

what is the problem with the patent ductus arteriosus

A

blood flows wrong direction

will lead to heart failure

36
Q

what should be done when treating patients with congenital abnormalities

A

there is an endocarditis risk
seek guidance from a cardiologist case by case
antibiotics may be required to conduct any dental care
check for infection risk during dental treatment
most of these conditions are mild and untreated

37
Q

what are tachy arrhythmias

A

fast heart rates
160-170 bpm
young people can cope with this during exercise
elderly can’t cope with this well and it may cause heart failure
can only move blood to coronary arteries during diastole so it compromises cardiac blood flow
lead to atrial fibrillation or ventricular fibrilation

38
Q

what are brady arrhythmias

A

slow heart rates
less common
can’t conduct from atria to ventricles
need rhythm to be maintained by a pacemaker
heart will beat around 30 bpm - this keeps you alive if you are lying down but can’t have movement with this
can be caused by a heart block or can be drug induced

39
Q

what drugs induce brady arrhythmias

A

> beta blocker

> digoxin

40
Q

what are cardiac pacemakers used to treat

A

brady arrhythmias
pacemakers are paced to keep the rhythm for the patient
keeps HR at a minimum level

41
Q

what can brady arrhythmias do to the patient

A

lower blood flow so the pressure drops and may cause patient to fall

42
Q

how do pacemakers work

A

they have 2 wires
> one checks the heart beat
> one is in the muscle that causes the heart to beat faster if the first wire detects the beat is too slow

43
Q

what is the problem with pacemakers

A 
risk of electrical interference
> electric fields
- MRI
- electrosurgery / diathermy
> dental equipment theoretical risk only
- pulp testers ok
- avoid induction scalers
- electromagnetic scaling devices = problem
44
Q

what is part of the sinus rhythm

A

PQRST wave

45
Q

what does the P wave show

A

atrial depolarisation

46
Q

what does the QRS complex show

A

ventricular depolarisation
narrow = signal moves very quickly, rapid conduction from Av node to muscle
size of spike varies on size of muscle

47
Q

what does the T wave show

A

ventricular repolarisation

48
Q

what is normal sinus rhythm like

A 
HR = 60-100 bpm
rhythm = regular
P wave = before each QRS, identical
PR interval = 0.12 to 0.20 seconds
QRS = <0.12 seconds
49
Q

what is ventricular fibrillation like

A 
HR = 300-600bpm
rhythm = extremely irregular
p wave = absent
PR interval = N/a 
QRS = fibrillatory baseline
50
Q

what is ventricular fibrillation

A 
unstable heart electrical activity
made worse by some medicines
occurs with
- heart attack
- electrocution
- long QT syndrome
- wolf-parkinson-white syndrome

no cardiac output
death usually follows unless debrillation occurs (treatment)

51
Q

what is ventricular asystole (standstill) like

A 
HR = absent
rhythm = absent
p wave = present or absent
pr interval = n/a 
qrs = absent
52
Q

when do you get a completely flat line on an ECG

A

when it isnt plugged in

53
Q

how does lack of any electrical activity show on an ECG

A

wandering line

54
Q

what is atrial fibrillation like

A 
HR = A: 350-650bpm, V: slow to rapid
rhythm = irregular
p wave = fibrillatory (fine to course)
pr interval = n/a
qrs = <0.12 seconds
55
Q

what does atrial fibrillation look like

A 
normal but no p waves
irregularly irregular heart rate
pulse is strange
common condition
anticoagulatn needed to prevent clots in atrium to prevent strokes
56
Q

what is present in an ECG of a heart attack

A

st segment elevation

also suggests MI - only have3 complexes but happening simultaneously

BDS2 - Cardiovascular (3 decks)

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