Week 2 - Cardiovascular Medicine 2 Flashcards
structural heart disease: 2 examples?
heart failure
valvular heart disease
structural heart disease: investigations?
ECG - electrocardiogram
chest xray
echocardiogram
heart failure: causes? x5
- ischaemic heart disease
- hypertension
- valvular heart disease
- alcohol excess
- numerous other causes
heart failure: symptoms?
pump failure, due to:
- fluid accumulation: oedema
lungs -> breathlessness. could occur on exertion or lying flat
- swelling of peripheries: pitting oedema
heart failure: presentation?
- gradual onset
- can present acutely to hospital shortness of breath, often during night time while lying flat
heart failure: treatment?
- address underlying cause, e.g:
- ischaemic heart disease
- hypertension
- valvular heart disease
- alcohol excess + other causes - medication
- diuretics
- ACE inhibitors
- angiotensin II antagonists
- b-blockers
- digoxin - surgical
- CABG/PTCA for coexisting angina - pacemaker
heart failure: dental aspects
- polypharmacy?
- NSAIDs?
- patient lying flat?
- what to do when heart failure presenting?
- due to drug side effects, risk of interactions
- cause fluid retention. avoid them
- caution when lying patient flat
- ABCDE approach, potential cardiac arrest, use AED
valvular heart disease: which side commonly affected? which valves?
- left side of heart
- aortic and mitral valve
valvular heart disease: causes?
- congenital
- infective endocarditis
- rheumatic fever: complication of streptococcus infection), rare
- age-related: most common
valvular heart disease:
describe pathophysiology
- regurgitation
- loss of valve integrity
- becomes floppy
- results in leakage
- lead to heart failure - stenosis
- narrowing of valve
- obstruction of flow
- leads to inadequate output and pump failure
valvular heart disease: treatment?
- medication: treat heart failure
- surgery: valve replacement
- porcine (animal tissue)
- metallic (anticoagulation critical) requires warfarin
why is warfarin required when doing valve replacement?
valve is recognized as foreign body, will trigger coagulation, leading to thrombosis (bad). warfarin thins blood and prevents clotting
what is INR?
what is the normal INR + INR for metal valves?
- international normalised ratio: test used to monitor the effects of warfarin. blood test that checks how long it takes for blood to clot
- normal INR: 1.1
- for metal valves: 3
infective endocarditis: how is it induced?
how can it occur?
- induced by invasive procedures: dental procedures including tooth brushing
- can occur spontaneously: dental caries and gingivitis
valvular heart disease: infective endocarditis
- occurs on what type of valves?
- aetiology/due to?
- usually occurs on diseased or prosthetic valves
- trivial bacteraemia:
strep viridans
strep faecalis
staph aureus
valvular heart disease: infective endocarditis
- clinical features?
- prolonged febrile illness
- valve degeneration and failure
- embolic disease: brain, skin, anywhere
- immune complex formation: kidney failure
valvular heart disease: infective endocarditis
- how to investigate
- treatment?
- blood cultures, echocardiogram
- prolonged course of intravenous antibiotics, surgery may be necessary
valvular heart disease: dental aspects
- OH?
- prophylaxis?
- pts at risk of heart failure/collapse?
- pts at risk of endocarditis?
- maintain high standard of OH: avoid surgery if possible, avoid spontaneous bacteraemia
- prophylaxis no longer routinely given
- identify by taking good history, avoid treatment if unstable, caution with pt lying flat
- encourage good OH, practice good preventive dentistry
what is sinus rhythm?
normal cardiac rhythm
what is abnormal cardiac rhythm?
values for too fast/slow rates?
- arrhythmia: irregular heartbeat
- too fast: > 100/minute
- too slow: < 60/minute
- abnormal beat conduction
cardiac arrhythmia: symptoms?
- can be nil
- palpitations
- chest pain
- heart failure
- syncope: loss of consciousness due to fall in BP
cardiac arrhythmia: list of conditions?
- atrial fibrillation: irregular
- supraventricular tachycardia: too fast
- bradyarrhythmia: too slow
- ventricular arrhythmia: abnormal conduction
cardiac arrhythmia: atrial fibrillation incidence? symptoms? associated with? managed by what drugs? increased risk of?
- common: 10% of elderly
- often asymptomatic
- associated with cardiovascular disease: heart failure, angina, HBP
- digoxin, amiodarone, b-blockers, calcium antagonists
- increased risk of stroke: pt should be on anticoagulant
tachyarrhythmia: supraventricular tachycardia (SVT) - incidence? - benign? exception in? - precipitated by? - symptoms?
- common. often in otherwise healthy people
- usually benign, except in wolf-parkinson white syndrome
- precipitated by caffeine, infections and maybe anxiety
- unpleasant feeling, palpitations, chest pain, breathlessness
tachyarrhythmia:
supraventricular tachycardia (SVT)
- treatment?
- prevention?
- vagal manoeuvres e.g. valsava manoeuvre
- carotid sinus massage
- drugs e.g. adenosine
prevention:
- drugs
- surgery
bradyarrhythimia:
- heart rate of?
- what happens if rate < 40/minute?
- causes? x4
- treatment?
- < 60/minute
- dizziness and blackout
- age, ischaemia, drugs, may be physiological (athletes)
- remove underlying cause, usually drugs. pt may require pacemaker
cardiac arrhythmia: ventricular arrhythmia
- emergency? why?
- causes?
- a medical emergency, because it is peri-arrest rhythm
- usually ischaemic heart disease, drugs, congenital, electrolyte disturbance
ventricular arrhythmias:
- ventricular tachycardia: symptoms?
- ventricular fibrillation?
- breathlessness, dizziness, chest pain, palpitations, cardiorespiratory arrest
- always cardiorespiratory arrest
ventricular arrhythmias: treatment for both conditions?
- ventricular tachycardia:
immediate: hospitalization for defibrillation/drugs
long term: drugs, ICD (implantable cardiac defibrillator) - ventricular fibrillation:
immediate: defibrillation
long term: drugs, sometimes ICD
cardiac arrhythmia: dental aspects
recognize those at risk via?
if unstable?
how to recognize unwell patients?
- medical/drug history
- avoid treating
- light-headed, collapse
chest pain
breathlessness
sweaty, distressed
particular concerns; e.g. heart rate <40, >150, history of collapse, hypotension
cardiac arrhythmia: dental aspects
management of emergencies?
- ABC: remember oxygen
- hospitalization
- prepare to manage cardiac arrest: apply AED pads, switch on
cardiac arrhythmia: dental aspects
pacemakers: what to note?
LA?
- identify pts with pacemaker, do not require antibiotic cover, theoretical risk of electric interference
- avoid adrenaline containing LA; seek advice
