Cardiovascular

Question 1

pulmonary circulation

Answer 1

right side of the heart, which carries blood from the heart to the lungs and back to the heart

Question 2

systemic circulation

Answer 2

left side of the heart, which carries blood from the heart to the rest of the body and then back to the heart

Question 3

atherosclerosis

Answer 3

cells and lipids accumulate within the tunica intima not on the artery walls

Question 4

hypertension can lead to

Answer 4

hypertiensive heart disease

Question 5

two basic types of coronary heart disease

Answer 5

chronic ischemic heart disease
acute coronary syndromes

Question 6

chronic ischemic heart disease

Answer 6

stable angina
silent myocardial ischemia

Question 7

acute coronary syndromes

Answer 7

unstable angina
acute myocardial infarction
sudden death
ventricular fibrillation

Question 8

coronary heart disease medication side effects

Answer 8

xerostomia
calcium channel blockers (gingival hyperplasia)
antithrombotic treatment regimen: anticoagulant/antiplatelet therapy (excessive bleeding)

Question 9

peripheral artery disease

Answer 9

atherosclerosis of the arteries in the lower extremities

Question 10

dental implications peripheral artery disease

Answer 10

if taking anticoagulants, know the coagulation status
side effects of other meds
patient education
evaluate for perio disorders
possible referral

Question 11

abdominal aortic aneurysm

Answer 11

weakness of the aorta causing an enlargement or bulging of the artery
aneurysm located in abdominal aorta

Question 12

abdominal aortic aneurysm dental implications

Answer 12

side effects of medications
stress importance of maintaining healthy oral tissue
identification of individual at risk may prompt a medical referral

Question 13

raynaud disease or phenomenon pathogenesis

Answer 13

ischemia caused by vasospasm in the vessels of the extremities and sometimes ears and nose
brought on by cold or emotional stress
associated with smoking

Question 14

raynaud disease or phenomenon dental implications

Answer 14

refer for medical evaluation
side effect of medications

Question 15

thromboembolic venous disorders

Answer 15

formation of blood clots
can break away and lodge anywhere
deep vein thrombosis (DVT)

Question 16

dental implications of thromboembolic venous disorders

Answer 16

low dose anticoagulant therapy (no risk of blood loss)
stronger anticoagulants (increase the risk of uncontrolled bleeding)
medical consultation to determine coagulation status
local hemostatic measures

Question 17

common blood thinners

Answer 17

warfarin
eliquis
xarelto
pradaxa
heparin

Question 18

2 forms of stroke

Answer 18

ischemic - thrombus/embolus
intracranial hemorrhage - trauma, hypertension, aneurysm

Question 19

pathogenesis of stroke

Answer 19

blood obstructed by growing thrombus, or by an embolus
tissues distal to obstruction become damage and necrotic
resulting pressure in cranium due to blood flow causes an interruption of blood flow to tissues

Question 20

perioral and intraoral characteristics after stroke

Answer 20

unilateral weakness may affect: chewing, swallowing, ability to clear the mouth of residual food
uncontrollable drooling
favor chewing on unaffected side of mouth
food pocketing
motor impairment

Question 21

dental implications of stroke fall into four categories

Answer 21

management of side effects of meds
management of post stroke physical effects
home care modifications
emergency management of stroke

Question 22

dental implications of stroke - management of side effects of meds

Answer 22

determine coagulation status
provide local hemostatic measures
avoid tissue trauma
xerostomia management
calcium channel blockers may cause gingival overgrowth

Question 23

knowledge of heart disorders will enable the dental professional to

Answer 23

recognize potential problems
modify the treatment to protect the patient and provide the safest possible therapy

Question 24

shunts cause

Answer 24

mixing of oxygenated and deoxygenated blood

Question 25

ventricular septal defect

Answer 25

hole in septal wall between left and right ventricles causing mixing of blood higher risk for infective endocarditis, aortic valve prolapse and blood clots eventual congestive heart failure clubbing of fingertips fatigue, shortness of breath and tachycardia

Question 26

finger clubbing is an important feature with

Answer 26

chronic hypoxia cyanosis

Question 27

atrial septal defect

Answer 27

hole in the wall between the right and left atria cyanosis and hypoxia abnormal heart beats (dysrhythmias) clubbing of fingers higher risk for infective endocarditis and emboli

Question 28

patent ductus arteriosus

Answer 28

ductus arteriosus does not close after birth premature babies heart murmur development of pulmonary hypertension higher risk for infective endocarditis and arteritis

Question 29

pulmonary stenosis

Answer 29

narrowing of pulmonary valve caused by a fusion of the valve cusps forming a funnel when the valve opens instead of a wide opening if severe- will be difficult for the heart to pump blood into the lungs CHF may result

Question 30

tetralogy of fallot (TOF)

Answer 30

4 defects: VSD, PD, overriding aorta, and right ventricular hypertrophy right to left shunting of blood, cyanosis and hypoxia shortness of breath polycythemia - abnormal increase in the number of red blood cells increased risk of infective endocarditis, emboli, brain abscesses, acute episodes of cyanosis during which seizures, loss of consciousness and sudden death are possible

Question 31

coarctation of the aorta (COA)

Answer 31

constriction of the aorta BP and pulse in the upper body differs compared to the lower body lower volume of blood is able to get past constriction left ventricular hypertrophy, dizziness, headache, epistaxis weakness, pain, pallor and coldness in lower extremities arteritis at constriction site untreated - increase risk for stroke, ruptured aortic and cerebral aneurysms, infective endocarditis at the aortic valve

Question 32

transposition of the great arteries (TGA)

Answer 32

aorta exits from right ventricle and pulmonary artery exits from left ventricle most times also septal defect if no septal defect to allow for mixing of blood then is fatal cyanosis and hypoxia

Question 33

dental implications of congenital heart defects

Answer 33

presence of cyanosis should have medical investigation prior treatment modifications - prophylactic antibiotics supplemental oxygen stress reduction techniques caution administering local anesthetics patients ed - link of oral infection and bacterial endocarditis how adequate OH can decrease the risk of an autogenous infection

Question 34

dental antibiotic prophylaxis

Answer 34

antibiotic given to a patient for prevention of harmful consequences of bacteremia that may be caused by oral flora

Question 35

heart valve defects

Answer 35

narrowing of heart valves muscles of heart have to compensate insufficient heart valves do not close all the way, causing regurgitation muscles will compensate to try to push more blood through blood flow through valve is more turbulent causing more damage heart eventually weakens and congestive heart failure will result

Question 36

two kinds of heart valve defects

Answer 36

benign/physiologic murmurs pathologic murmurs

Question 37

pathologic murmurs

Answer 37

caused by valve defect stenotic valves - symptoms manifest when the heart is under stress shortness of breath, possible chest pains

Question 38

benign/physiologic murmurs

Answer 38

mostly heard in small children grow out of, no treatment needed no risk for endocarditis

Question 39

heart valve defects dental implication

Answer 39

daily home care could cause bacteremia bacteria within the blood to attach to endocardium no prophylactic antibiotics for physiologic heart murmurs anticoagulant therapy (xerostomia) individuals with valve replacement are at a high risk for bacterial endocarditis and thrombus formation (may be on prophylactic antibiotics, augmented antibiotic prior to, consultation with patient's physician)

Question 40

mitral valve prolapse dental implications

Answer 40

the ADA no longer requires prophylactic antibiotic coverage with or without regurgitation education should be given to patients on the importance of decreasing the risk of creating a bacteremia that might result in infective endocarditis

Question 41

rheumatic heart disease dental implications

Answer 41

patients may be on anticoagulants patients may be on daily antibiotics should be suspected for patients reporting a history of rheumatic fever (at risk for recurrence, which could cause more heart damage)

Question 42

infective endocarditis etiology

Answer 42

bacteria (staphylococcus and streptococcus) gram negative bacillus, yeast, fungi bacteremia must be present can form in a healthy heart, but develops most often in a heart compromised

Question 43

infective endocarditis peri/intraoral characteristics

Answer 43

petechiae may be found on any of the oral mucosal surfaces, especially soft palate and buccal mucosa

Question 44

infective endocarditis extraoral characteristics

Answer 44

fever, chills, shortness of breath, could have low grade fever and flu like symptoms

Question 45

dental implications of infective endocarditis

Answer 45

prophylactic antibiotics prior to dental treatment gingival and periodontal infections are the most common source of transient bacteremia identify persons at risk

Question 46

congestive heart failure perioral and intraoral characteristics

Answer 46

cyanosis of the lips and oral tissues severe: right side jugular vein may become distended and can be observed when patient is in an upright position

Question 47

dental implications of congestive heart failure

Answer 47

xerostomia because of medications for CHF modifying the chair to a semi-upright or upright might be indicated as well as supplemental oxygen to aid in breathing

Question 48

dysrhythmias

Answer 48

abnormal heart rhythms or beats

Question 49

tachycardia

Answer 49

fast heartbeat

Question 50

bradycardia

Answer 50

slow heartbeat

Question 51

dental implications of dysrhythmias

Answer 51

often able to identify abnormal heart rhythms refer to physician implanted pacemakers or defibrillators do not indicate the need for prophylactic antibiotic coverage careful using magnetostrictive devices around unipolar pacemakers bipolar and ICD