Lecture 2- Cardiovascular Disease I Flashcards
what is the most common cause of premature death in the world
cardiovascular disease
patients frequently have _____ CVD
more than one
what are the types of CVD
- HTN
-atherosclerosis - angina pectoris
- CHF
- arrhthmias
-bacterial endocarditis
what does atherosclerosis lead to
coronary artery disease leading to infarction
what is bacterial endocarditis caused by
infection, inflammation and scarring
what is CHF
- dilated ventricles with weak muscles
- thickened myocardium
what is arrhythmia
uncoordinated electrical signals
what is valvular disease characterized by and what does it lead to
- stenotic and not capable of full closure for blood circulation
- leads to CHF
what are the conditions that are risk factors for CVD
- high BP
- high cholesterol
- diabetes
- rheumatic fever
- more than one CVD
why is high BP a risk factor for CVD
- stiffens vessels which reduces blood flow
- risk for stroke, kidney disease and dementia
why is diabetes a risk factor for CVD
unstable glucose levels affect healthy myocardium function; angiopathy
what are the behaviors that are risk factors for CVD
- unhealthy diet
- physical inactivity
- obesity
- too much alcohol
-tobacco use - stress
what constitutes an unhealthy diet in CVD risk factors
- carbs, fat, caffeine, sodium
why is physical inactivity a risk factor for CVD
poor circulation
why is obesity a risk factor for CVD
excess weight stresses heart function, HTN, CAD
why is too much alcohol a CVD risk factor
increases BP, arrythmias
why is tobacco use a CVD risk factor
increases HR, BP, CAD
what family history is a risk factor for CVD
- genetics
- becoming older
- ethnicity
what are predisposing etiologies for CVD
- congenital
- hypertension (positive CVD feedback cycle)
- ischemia (positive CVD feedback cycle)
- inflammation
what are the contributary anatomic abnormalities for CVD
- hypertrophy
- dilation
- valves
- regurgitation
- stenosis
what are the late stage physiologic changes in CVD
- arrhythmias
- heart failure
- ischemia
what stages do we treat in dentistry for CVD patients
class I or class II
what are some signs of CVD
- elevated BP
- irregular HR
- abnormal RR
- SOB
- prolonged bleeding
- surgical scars
- easy bruising
what are symptoms of CVD
patient is uncomfortbale in supine position
what are the dental treatments in the low level intervention category
- health/medical evaluation
- exams
- prophy
- radiographs
- optical oral scans
- alginate impressions
what are the dental treatments that fall in the moderate intervention category
- SRP
- simple restorative procedures on 1-2 teeth
- simple extractions on 1-2 teeth
-restorative impressions needing retractions and longer setting times
what dental procedures fall under high risk intervention cateogry
- complex restorative treatment on more than 2 teeth
- multiple extractions
- surgical extractions
- implant placement
- full arch impressions
- dental care under general anesthesia
what does the renin-angiotensin aldosterone system do
maintains physiologic BP when BP is low
describe primary HTN
- mutlifactorial, gene-environment
- 90-95% of cases
what are the causes of secondary HTN
- renal disease and renin-producing tumors
- endocrine
- cardiovascular
- neurologic
what endocrine disorders can cause secondary HTN
- adrenal
- exogenous hormones
- pregnancy
- pheochromocytoma
- thyroid
what neurologic disorders can cause secondary HTN
- psychogenic
- sleep apnea
- intracranial vascular pressure
- exogenous
what are the complications of HTN
- MI
-stroke - CAD
- peripheral artery disease
- heart failure
- retinopathy
- end stage renal disease
what is the number for normal BP
- less than 120/ less than 80
what is the number for elevated BP
120-129/less than 80
what is the number of hypertensive crisis
higher than 180 and or/ higher than 120
how many BP readings do you need to make a dx
more than 2 readings on 2 separate visits
what is BP measured by
determined by indirect measurement in the upper extremities with a BP cuff and stethoscope
cuff should encompass ___ of the circumference of the arm
80%
center of cuff over _____
brachial artery
white coat HTN elevates BP by
30mmHg
how are pregnant patients BP affected
greater than 10 mmHg increase in systolic BP
what is the risk of high BP in pregnant patietns
eclampsia
HTN goals depend on:
patient age and comorbidities
what is the normal goal for patients with HTN
between less than 130-149/80-90 mmHg
what BP is the cut off for tx at UMKC
greater than or equal to 180/110 mmHg
what do you do if a patient presents with BP greater than 180/110 and is symptomatic
ER
what are the lifestyle modifications for HTN
- diet - increase fruit intake, decrease sodium, increased potassium
- physical exercise/weight loss
- tobacco cessation and alcohol intake reduction
what is the daily limit for alcohol for men and women
no more than 4 for men and no more than 3 for women
what are the ACE inhibitor drugs and their side effects
- lisinopril
-captopril - angioedema, neutropenia/agranulocytosis, taste disturbances
what are the calcium channel blocker drugs and their side effects
- nifedipine, dilitazem
- gingival overgrowth, dry mouth, taste disturbances
what are the diuretic drugs and their side effects
- hydrochlorothiazide
- spironolactone
- hydrochlorothiazide, furosemide
- dry mouth
what are the alpha adrenergic blockers and their side effect
- methyldopa
- dry mouth
what are the beta adrenergic blockers and side effect
- atenolol, oxprenolol, practolol
- propranolol
- dry mouth, angioedema
what are the side effects of pharmacotherapy for HTN
- dry mouth
- burning mouth
- taste changes
- angioedema
- gingival hyperplasia
- lichenoid reactions
- lupus like lesions
what drugs cause dry mouth
anti adrenergic and diuretics
what drugs cause burning mouth
ACE inhibitors
what HTN drugs cause taste changes
antiadrenergics and ACE inhibitors
what HTN drugs cause angioedema
ACE inhibitors and ARB
what HTN drugs cause gingival hyperplasia
calcium channel blockers
what HTN drugs cause lichenoid reactions
thiazides, methyldopa, propranolol and labetalol
what HTN drugs cause lupus like lesions
hydralazine