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bds 2 > acute coronary systems > Flashcards

acute coronary systems Flashcards

1
Q

cvs risk factors

A

hormones, family history, genetics, smoking, diet, lack of exercise, diabetes, obesity, socio-economic

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2
Q

primary prevention

A

stop the onset by giving advice/ treatment

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3
Q

secondary prevention

A

preventing consequences post early diagnosis

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4
Q

interconnected nature of cardiovascular disease lies within

A

there are vessels everywhere in the body

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5
Q

ischemia

A

blood flow & oxygen restricted to the certain part of the body

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6
Q

infarction

A

tissue death due to inadequate blood supply to the area

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7
Q

narrow vessels called

A

atheroma

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8
Q

exceeded oxygen in blood vessels

A

builds lactic acid

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9
Q

most common areas of infarction

A
  • Heart - coronary artery atheroma
  • Limb - femoral & popliteal arteries
  • Brain - carotid arteries
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10
Q

main symptom of angina

A

tightness of the chest, exercise brought, relived by rest; dizziness, fatigue, nausea, shortness of breath

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11
Q

angina cause

A

atherosclerosis of coronary arteries supplying blood to the heart muscles

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12
Q

prevention of stable angina

A

low dose aspirin to reduce MI risk, diuretics, statins, ace inhibitors and beta blockers, lifestyle changes

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13
Q

coronary artery bypass

A

to improve blood flow

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14
Q

emergency angina treatment

A

GTN (glycerol trinitrate) under the tongue for first pass metabolism

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15
Q

GTN mode of action

A

GTN reduces the cardiac workload by relaxing the vessels, matching oxygen delivery to work and give relief to a patient

high venous contraction during angina increases the work so you need to reduce the preload or afterload

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16
Q

stemi symptoms

A

chest pain, often described as crushing or pressure-like feeling, radiating to the jaw and/or left arm, difficulty breathing, nausea

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17
Q

acute coronary syndromes

A

stemi, nstemi, stable and unstable angina

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18
Q

stemi treatment

A

PERCUTANEOUS CORONARY INTERVENTION (pci) = angioplasty within 3 hours and thrombolisers therapy

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19
Q

what is stemi

A

blockage of the coronal artery
reflected by ecg ST segment elevation and rise in troponin

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20
Q

what is nstemi

A

non-st-elevation - partial blockage of one of the coronary arteries, causing reduced flow of oxygen-rich blood to the heart muscle

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21
Q

management of unstable angina

A

asririn, nitrates, beta blockers, statins, calcium channel blockers

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22
Q

angina signs

A

hyperdynamic circulation, anaemia, hyperthyroidism

23
Q

investigations for angina

A

ecg resting and after exercise, angiography

24
Q

treatment for hypertension within angina

A

diuretics, Ca channel blockers, ace inhibitors, beta blockers

25
Q

antiplatelet drugs

A

asprin and clopidogrel - inhibit platelet aggregation - decreases stroke and MI risk

26
Q

aspirin risk dentistry

A

prolong the bleeding time following dental extraction

27
Q

oral anticoagulants

A

warfarin and apixaban, taken to inhibit a clotting effect
warfarin is a vitamin k antagonist

28
Q

warfarin dentistry

A

prolonged bleeding, INR has to be 2-4, avoid ID block, NSAIDs and fluconazole

29
Q

apixaban

A

short half life and can be given as a short course for DVT, postpone extraction till after

30
Q

statins are

A

lipid lowering drugs e.g. simvastatin, inhibit cholesterol synthesis in the liver so they reduce total cholesterol and LDL-cholesterol

31
Q

do not prescribe statins with

A

antifungals

32
Q

beta blockers

A

stop arrhythmias leading to cardiac arrest (Ventricular fibrillation – VF)
reduces heart muscle excitability, prevent increase in heart rate, reduce heart efficiency

  • Atenolol – selective - β1 only
  • Propranolol – non-selective – β1 and β2
33
Q

diuretics

A

remove salt and water from body, can lead to Na+/K+ imbalance if not monitored carefully and can lead to dry mouth in the elderly

34
Q

nitrates

A

Short acting – Glyceryl Trinitrate (GTN) - reduces chest pain through first pass metabolism
Long acting – Isosorbide Mononitrate - prevention of angina

35
Q

calcium channel blockers

A

block calcium channels in smooth muscle - relaxation and vasodilation
e.g. Nifedipine, amlodipine (-pine)

36
Q

ca channel blockers in dentistry

A

can lead to gingival hyperplasia in some, need to keep good OH

37
Q

angiotensin converting enzyme (ACE) inhibitors

A

many on the market (-pril ending)
* Enalapril
* Ramapril
* Lisinopril
inhibit conversion of angiotensin I to angiotensin II
prevents aldosterone dependent reabsorption of salt and water.
reduce blood pressure
reduce excess salt and water retention

38
Q

what are STEMI implications for his routine dental care of this diagnosis?

A

reduce anxiety and ensure right LA is given, be ready for BLS

39
Q

dental treatment after stent placement

A

should be at least 6 weeks after the surgery, might consider antibiotic prophylaxis

40
Q

patient 1 takes warfarin for atrial fibrillation.

A

patients on warfarin need to have an international
normalised ratio (INR) check done within 72 h of the extraction; if they have an unstable INR this time interval drops to 24 h. If the INR falls within the range 1—4, it is deemed safe to carry out the extraction. (Care should be taken at the upper end of this range, especially if multiple teeth or surgical procedures may be necessary.) Local measures should also be employed such as packing the socket with a haemostatic agent,
eg oxidised cellulose or collagen sponge, or resorbable gelatin sponge, and the socket should be sutured. Good postoperative instructions should be given and nonsteroidal anti-inflammatory drugs (NSAIDs) should not be prescribed

Postoperative tranexamic acid mouthwash may also be considered

41
Q

patient 2 takes aspirin after a myocardial infarction

A

patient 2 takes aspirin and usually extractions can be carried out without any ill effect. If excessive bleeding occurs on removal of the tooth, it would be prudent to pack and suture the socket as in patient 1 and prescription of NSAIDs should be avoided

42
Q

patient 3 takes aspirin and clopidrogrel after
placement of a cardiac stent.

A

clopidrogrel and aspirin may cause postoperative
bleeding, so it is good practice to pack and suture all sockets as in patient
The prescription of NSAIDs should be avoided, but postoperative tranexamic acid mouthwash may be considered. There is no preoperative blood test that is recommended

43
Q

patient 4 takes aspirin and dipyridamole for stroke
prevention.

A

Dipyridamole and aspirin are a less potent combination than clopidrogrel and aspirin, and patients can be safely managed in the same manner as those on aspirin alone

44
Q

patient 5 takes dabigatran etexilate (a thrombin
inhibitor) for atrial fibrillation.

A

Dabigatran etexilate is a new thrombin inhibitor. It
differs from warfarin in that vitamin K is not an effective reversal agent, and the drug’s action is not monitored by measuring the INR. It has a much shorter half-life of 12— 17 h, but this depends on renal activity. In patients
with poor renal function the half-life is increased
As there are no guidelines at present on how to
manage patients on these drugs who require surgical procedures in dentistry, it would be sensible to liaise with the patient’s haematologist about management. It would seem prudent to check the patient’s renal function if possible because this will give an indication
of the drug’s half-life. It is also suggested that the
patient should be treated as late as is feasibly possibly after administration of the drug, eg if the patient takes it at night, then treat the following afternoon. Local measures such as packing, suturing and postoperative administration of tranexamic acid mouthwash are also suggested

45
Q

list three medical conditions for which patients
may be prescribed warfarin.

A

Atrial fibrillation
Prosthetic heart valves
Deep vein thrombosis
Pulmonary embolus
Cerebrovascular accident
Antiphospholipid syndrome

46
Q

drugs that interact with warfarin

A
  • Fluconazole — enhances anticoagulant effect
  • Metronidazole — enhances anticoagulant effect
  • Carbamazepine (epilepsy) — reduces anticoagulant effect
47
Q

what type of drug is tranexamic acid?
how is it administered and when would it be used?

A

tranexamic acid is an ANTIFIBRINOLYTIC agent

used topically as a mouthwash or by soaking swabs in it and getting the patient to bite on them
can also be given orally or intravenously

used to prevent and control bleeding especially during and after the procedure.

48
Q

What are the dental implications of the
following findings in a patient’s medical history:
(a) The patient is taking glyceryl trinitrate (GTN).

A

GTN is a vasodilator and also reduces left ventricular work by reducing venous return.

Reducing stress by providing good anaesthesia and not subjecting patients to long appointments will minimise the likelihood of the patient having an attack.

In addition,the patient should take GTN at the start of an appointment.

49
Q

What are the dental implications of the
following findings in a patient’s medical history:
The patient is taking nifedipine.

A

Nifedipine is a calcium-channel blocker used to treat
hypertension.
Hypertensive patients are at increased risk of other cardiovascular disease.
Routine dental treatment may need to be postponed if the patient’s blood pressure is greater than 160/110 mmHg.
Hypertensive patients are more likely to have
EXCESSIVE BLEEDING following extractions.

Ca+ Channel Blockers can cause gingival hyperplasia.

50
Q

You are carrying out a dental extraction on a 70-year-old man in your practice. He pushes your hand away and tells you to stop leaning on his chest (which you are not doing). What is the likely diagnosis?

A

Angina

51
Q

What other symptoms may he be
experiencing?

A

The patient may also be experiencing:
* Central chest/retrosternal pain
* Band-like chest pain
* Pain radiating to the mandible/left arm

52
Q

How would you proceed in this situation?

A

Management of ischaemic chest pain:
1 Stop the procedure
2 Make the patient sit up
3 Administer sublingual GTN
4 Administer oxygen

53
Q

The pain continues and becomes more severe.
He becomes pale, clammy and feels nauseous.
What has happened?

A

The ischaemic chest pain has progressed from angina (reversible) to MYOCARDIAL INFARCTION (irreversible).

54
Q

How would you proceed?

A

call for help from nursing staff
call 999
prepare for BLS
30 compressions to 2 rescue breaths
15 l of oxygen
use defibrillator if possible

bds 2 (38 decks)

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