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dh 2 > Exam 2 Powerpoint > Flashcards

Exam 2 Powerpoint Flashcards

1
Q

What is Cardiac Arrhythmia?

A

Variation in the normal heartbeat: rhythm, rate or conduction pattern of heart is distrubed.

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2
Q

Cardiac Arrhythmia is influcenced by ?

A
  • Strong emotions
  • Certain drugs
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3
Q

Cardiac arrhythmia can lead to ?

A

anxiety, loss of consciousness, possible death

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4
Q

Who are at risk for cardiac arrthymias?

A
  • Older adults
  • Long term smokers and drinkers
  • People with Ischemic heart disease
  • Taking certain drugs and specific systemic diseases
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5
Q

What are the drugs/food that can induce tachycardia?

A
  • Atropine
  • Epinephrine
  • nicotine
  • Ephedrine
  • Caffeine
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5
Q

What are the drugs/food that can induce bradycardia?

A
  • Digitalis
  • Morphine
  • Beta-blockers
  • Calcium channel blockers
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5
Q

What are the common conditions for cardiac arrhythmias?

A
  • Primary cardiovascular disorders
  • Pulmonary disorders
  • Autonomic disorders
  • Systemic Disorders
  • Drug-related adverse effects
  • Electrolyte imbalances
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5
Q

What is the etiology for cardiac arrthymia?

A
  • Occurs when the electrical signals that coordinate heartbeats do not work correctly
  • may cause the heart to beat too fast or too slow
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6
Q

What are the arrhythmia symptoms ?

A
  • Rapid heartbeat or irregular heartbeat
  • A fluttering feeling in your chest
  • Chest pain trouble breathing
  • Weakness
  • Dizziness or light headedness
  • Fainting
  • Fatigue
  • Sweating
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7
Q

what are the medical management for cardiac arrhythmias ?

A
  • meds are the first
  • calcium channel blockers, beta blockers, postassium channel blockers drugs of variable mechanisms oral anticoagulants
  • Other treatment options are implemented if medications are not effective
  • Cardioversion implanted pacemakers, implantable carioverter-defrib, radiofrequency ablation and surgery.
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8
Q

For oral anticoagulants what increases the risk for stroke and blood clots?

A

Atrial fibrillation

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9
Q

What are direct oral anticoagulant?

A
  • Pradaxa
  • Eliquis
  • Xarelto
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10
Q

What are the dental management for cardiac arrhythmias?

A
  • Thorough Medical Hx, Vital signs to identify patients at risk
  • Known history of arrhythmia
  • Consult with physician if symptoms are present or if pulse is irregular

**No premedication needed **

  • short , morning appts for complex procedures
  • Employ stress reduction protocols
  • anesthesia with vasoconstrictor is safe, only 2
  • Oral anticoagulants bleeding is a consideration, obtain recent INR between 2-3.5
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11
Q

What is congestive heart failure?

A

caused by inability of the heart to function effeciently as a pump
- decrease in cardiac output
- incomplete filling or emptying of the ventricle

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12
Q

If Congestive heart failure is poorly managed or goes untreated what happens?

A

Cardiac arrest, stroke and myocardial infraction

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13
Q

What is the most common cause of heart failure?

A
  • Coronary heart disease
  • Hypertension
  • Cardiomyopathy
  • Valvular heart disease
  • Myocarditis
  • Infective endocarditis
  • Congenital heart disease
  • Pulmonary hypertension
  • Pulmonary embolism
  • Endocrine disease
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14
Q

What are signs of heart failure?

A
  • Rapid shallow breathing
  • Hyperventilation
  • inspiratory cracking
  • heart murmur
  • increased heart rate
  • gallop rhythm
  • pulus alternans
  • distended neck veins
  • large liver
  • jaundice
  • peripheral edema
  • ascites
  • cyanosis
  • weight gain
  • clubbing of fingers
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15
Q

What are the symptoms of heart failure?

A
  • dyspnea
  • fatigue and weakness
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • acute pulmonary edema
  • exercise intolerance
  • fatigue
  • dependent edema
  • weight gain
  • Upper right quad pain
  • Anorexia
  • Hyperventilation
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16
Q

What is the medical management for Heart failure?

A
  • Stage A and B: do not include heart damage, identify and treat other conditions and risks, lifestyle modifications.
  • Stage C: stage A and B with salt restriction and medications
  • avoid NSAIDS, calclium channel blockers and antiarrhythmics.
  • Stage D: mechanical and surgical treatment
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17
Q

What are some dental considerations for heart failure?

A
  • Determine the risk vs benefit of treamtent by consulting with physician
  • Compensated HF posses intermediate risk during dental care (Class I)
  • PT who have uncompensated HF are not candidates for elective care
  • Severe Class III and All Class IV Pts needs to receive care ina hospital dental clinic
  • Antibiotic premedication possble for LVAD
  • Avoid NSAIDS
  • Anticoagulant therapy for possible excessive bleeding
  • anethesia with vasoconstrictor safe for Class I or II; max 2 cartridges
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18
Q

What are the oral manifestations for HF ?

A
  • No oral manifestations of HF
  • Medications may cause dry mouth or oral lesions
19
Q

What is hypertension?

A
  • abnormal elevation in arterial pressure
  • can be fatal if left untreated
  • Clinical signs and symptoms may not be present
  • Prevalence: both genders, increase with age
  • Leads to damage kidneys, heart, brain and eyes
20
Q

What is the etiology for primary hypertension?

A

No etiology: majority of individuals who have HBP

21
Q

What is the etiology for secondary hypertension?

A

underlying conditions like
* chronic kidney or renovascular disease
* chronic steroid therapy
* narrwoing aorta
* medications
* pheochromocytoma
* adrenal gland condition
* sleep apnea
* thyroid or parathyroid disease
* white coat syndrome

22
Q

What is BP classification?

A
  • Classification and diagnosis determined by physician based on average of 2 or more readings on two or more office visits
23
Q

What are the BP categories?

A
  • Normal: 120/less and 80/less
  • Elevated: 120-129 and 80/less
  • High BP (Stage 1) 130-139 or 80-89
  • High BP (Stage 2) 140/higher or 90/higher
  • Hypertensive crisis 180/higher or 120/higher
24
Q

What are the clincial predictors of increase perioperative Cardiovascular risk?

A
  • Major: Unstable coronary syndromes, decompensated HF, major arryhthymias, sever valvular disease.
  • Intermediate: HX of ischemic heart disease, HX compendated or prev HF, HX CVD, diabetes mellitus, renal insufficiency
  • Minor RF: Advanced age, abnormal ECG, Rhythm other than sinus uncontrolled HBP
25
Q

What are some dental considerations for Patients with Hypertension ?

A
  • Possibility of sudden acute elevation in BP during dental appts, this can lead to stroke, heart attak and other serious outcomes.
  • lower BP in the afternoon (PM appts preferred)
26
Q

How to best manage stress during a dental appointment?

A
  • By having short morning appointments
27
Q

What are the oral manifestations for hypertension.

A
  • Medications may cause dry mouth
  • Lichenoid reaction possible from thiazides, methyldopa, propranolol and labetalol

medications ending in OLOL=Hyperplasia

28
Q

What does ACE inhibitors do?

A

Delayed healing, bleeding, angioedema, cough and oral burning sensations

29
Q

What does Calcium channel blockers do?

A

Causes gingival overgrowth

30
Q

What is Ischemic heart disease ?

A
  • Thickening of the innermost layer of the arterial wall due to accumulation of lipid plaques.
31
Q

What are the most common underlying cause of Ischemic heart disease/coronary heart disease?

A
  • angina
  • Myocardinal infraction
  • Stroke
  • Peripheral arterial disease
32
Q

What are the risk factors of Ischemic heart disease?

A
  • Male gender
  • Older age
  • family history of CVD
  • Hyperlipidemia
  • Hypertension
  • Smoking
  • Physical inactivity
  • Obesity
  • Insulin resistance
  • Diabetes
  • Stress
  • Depression
33
Q

What are symptoms ischemic heart disease?

A
  • Chest pain
  • Heart palpitations
  • Lack of blood
  • Angina pectoris/chest pain lasts about 5-15 minutes, radiates in shoulder, arm, neck or mandible .
34
Q

What is stable angina pectoris?

A
  • 3-5 min consisten pain
  • stops with rest, removal of cause or nitroglycerin
  • Provoked by excerise or stress
  • Patient can predict attack
  • Med: Nitroglycerin
35
Q

what is unstable angina pectoris?

A
  • new onset of pain: different or irregular without prediction
  • Increases in frequency and intensity
  • may occur when at rest or exertion
  • meds does not releive
  • no elective dental treatment
  • can lead to myocardica infraction
36
Q

Whatare the medical management of angina pectoris?

A
  • identify and treat causative conditions
  • Reduce cardiovascular risk factors: HBP smoking, High Cholestrol, sedentary lifestyle, poor diert, obesity.
  • Pharm: nitroglycerin, beta blockers, anticoagulant drugs, statins
  • Surgery
37
Q

What are the symptoms of myocardial infraction?

A
  • Deep chest pain radiatiing to back jaw left arm
  • Cold sweat, weakness, faintness, breath shortness
  • Women symptoms deffer from men
  • Pain is more sever and last longer than angina.
38
Q

What are the oral manifestations of ischemic heart disease ?

A
  • May be associated with periodontal disease, poor oral health and tooth loss.
  • Medications may cause dry mouth, changes in taste perception and stomatitis
  • Calcium channel blockers may cause gingival overgrowth
  • Panoramic can detect cartoid calcification
39
Q

What is infective endocarditis?

A

Microorganisms colonize the endothelial ( lining ) of the heart or heart valves.

40
Q

What is the etiology of IE?

A
  • caused by streptocci, staphylococci and enterococci
  • Oral bacteria have often been found; dental procedures have been long-believed cause of IE.
41
Q

Infective endocarditis occurs in?

A
  • middle-age
  • edlerly
  • Men vs women
  • Previous IE
42
Q

What are the complications of IE?

A
  • Heart attack
  • abscesses
  • stroke
  • blood clots
  • septic shock
  • invasive infection
  • heart failure
  • death
43
Q

What is the treatment for IE?

A

Antibiotics have been administered before invasive dental procedures to prevent these infections.

44
Q

What is the current American Heart Association recommendations for prophylactic antibiotic
premedication for the prevention of bacteremia from an invasive dental procedure.

A

Antibiotic prophylaxis prior to dental treatment is controversial, because no data shows that it decreases in bacteria or reduces the risk or prevnt incidence of IE.

45
Q

What are the signs and symptoms of IE with bacteremia?

A

Fever
Heart murmur
Positive blood culture

46
Q

What are the dental procedures that require antibiotic premedications?

A
  • Any that involve manipulation if gingival tissue : Calculus detection, perio probing, deposit removal.
  • Any that involve manipulation of the periapical region of teeth: endodontoic procedures.
  • Any that involves perforation of the oral mucosa: oral surgeries
47
Q

What are the dental procedures that DO NOT require antibiotic premedications?

A
  • Radiographs
  • IO/EO
  • Dental Charting without sub exploration
  • Routine injections to administer anesthesia
48
Q

Conditions requiring antibotic premed?

A
  • Prosthetic cardic valves
  • Congenital heart disease
  • Previous relapse or recurrent infective endocarditis
  • Cardiac transplant recipents who develop cardiac valulopthay
49
Q

The AHA does not recommended routine antibiotic prophylaxis for PT with _____ to undergo dental procedures.

A

nonvalvular cardiovascular devices

dh 2 (21 decks)

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