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201 > cardiovascular > Flashcards

cardiovascular Flashcards

(59 cards)

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1
Q

What might palpitations be an early sign of

A

Heart disease

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2
Q

What should the heart do if it is functioning properly?

A
  • Beat in a stable and regular rhythm-rate consistent with adequate cardiac output
  • Heart muscle healthy and properly nourished
  • heart valves ensure unidirectional streamlined flow
  • peripheral resistance within normal limits
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3
Q

What is ischaemic heart disease

A
  • cornary arteries blocked due to plaque within lumen (atherosclerosis)
  • Artery spasm
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4
Q

What is a cardiac arrythmia

A

irregular, too fast, too slow

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5
Q

What is congenital heart disease

A

perforations etc. allowing oxygenated and deoxygenated blood to mix, causing the heart to overwork

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6
Q

What is acquired heart disease

A
  • usually due to infection
  • rheumatic fever after strep throat
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7
Q

What can ischaemic, arrythmias, congenital, and acquired heart disease lead to?

A

Heart failure-> cardiac arrest-> death

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8
Q

What are some causes of primary hypertension

A
  • old age
  • genetics
  • ethnicity
  • smoking and vaping
  • alcohol
  • sedentary
  • lifestyle
  • stress
  • obesity
  • diabetes
  • medications
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9
Q

What are some causes of secondary hypertension

A
  • Kidney disease
  • substance abuse/alcoholism
  • cushing’s syndrome
  • phaechromocytoma
  • pregnancy & OCP
  • obstructive sleep apnoea
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10
Q

What is ‘normal’ blood pressure

A

120/80

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11
Q

risks and implications of hypertension

A
  • kidney damage
  • vision loss
  • headache, confusion, convulsions
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12
Q

Describe management of hypertension

A

Lifestyle:
- lose weight
- limit alcohol
- exercise
- reduce sodium intake
- maintain potassium, calcium, magnesium
- stop smoking
- reduce fat intake
Drug therapy

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13
Q

how is hypertension drug therapy approached

A
  • use of multiple drugs to reduce side effects: calcium channel blockers, Angiotensin II receptors, Direct vasodilators
  • direct vasodilators only used in severe cases
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14
Q

What are calcium channel blockers also known as and what do they do?

A
  • calcium antagonists
  • Cause relaxation of cardiac and vascular smooth muscle
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15
Q

What are some examples of calcium channel blockers

A
  • Verapamil
  • Diltiazem
  • Nifedipine
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16
Q

What calcium channel blockers can cause gingival hyperplasia

A
  • Phenytoin (dilantin)
  • Cyclosporin- A
  • Nifedipine (also felodopine and amlodipine)
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17
Q

What are some dental considerations with hypertension?

A
  • History (check for comorbidities)
  • Current status (controlled?)
  • do not treat 160/100-180/110
  • do not interrupt medications for dental treatment
  • reduce anxiety and stress (sedative?)
  • be aware of interaction with vasoconstrictors in LA
  • Peri and post-operative bleeding
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18
Q

What are some side effects of HTN medications

A
  • Oral mucosal changes/gingival hyperplasia
  • Dry mouth/taste disturbances
  • Postural hypertension
  • Diuretics
  • triple whammy (ACE inhibitor or ARB+Diuretic+NSAID)
  • Avoid recommending NSAIDs for pain relief
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19
Q

Explain ischaemic heart disease (IHD)

A
  • a group of diseases characterised by reduced blood supply to the myocardium (cardiac muscle
  • usually secondary to coronary artery disease (atherosclerosis of the coronary arteries)
  • Results in deprivation of oxygen and nutrients to cardiac muscle
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20
Q

Define ischaemia

A

Inadequate bloodflow to a part of the heart muscle caused due to constriction or blockage of the blood vessels supplying the myocardium

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21
Q

Define infarction

A

tissue damage or death as a result of ischaemia

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22
Q

Describe atherosclerosis

A

Cyclic injury and repair of vascular wall
- inflammatory cytokines and cholesterol buildup
- chronic inflammation leads to sclerosis
Rupture of atheromatous plaque in a coronary artery can lead to acute coronary event
- myocardial ischaemia (angina)
- Myocardial infarction (MI)

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23
Q

describe risk of ischaemic heart disease

A
  • Māori 1.6x higher than non māori
  • risk increases with age
  • men 1.9x more likely than women
  • male mortality rated almost double female
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24
Q

What are some modifiable risk factors for IHD

Study These Flashcards
A
  • hypertension
  • diabetes mellitus
  • hyperlipidemia
  • obesity
  • cigarette smoking
  • sedentary lifestyle
25
What are some non-modifiable risk factors for IHD
- Family history of CAD - Male gender - Age - Menopause
26
Describe angina pectoris
- Central, tightening chest pain with/without radiating symptoms to the left arm, left neck, or lower jaw - Represents myocardial ischaemia often as a result of CAD - usually no clinical signs but may complain of dyspnoea, faint feeling, dizziness - may not always be typical in character
27
What is angina pectoria often precipitated and relieved by
- exertion, stress, cold weather, heavy meals - rest or nitrated (eg GTN)
28
How is angina pectoris diagnosed
History and ECG changes and by an exercise ECG when safe to perform
29
What are some dental considerations for angina pectoris
- assess severity and control - ensure GTN available if required - reduce stress and anxiety - nitrous oxide- adjunct - avoid intravascular injections - be alert to patient
30
Describe acute angina pectoris management
- stop procedure - glyceryl tri-nitrate (GTN) - oxygen if required - other medications such as beta blockers, long acting nitrates
31
How does GTN work?, how is it administered, and what are some side effects
- increases cGMP levels and alters calcium fluxes allowing relaxation of vascular smooth muscle, leading to coronary vessel dilation - administered sublingually or buccally via a spray, tablet or paste - can cause intense headache and hypotension
32
Describe long term management of angina pectoris
Lifestyle modification - lose weight - exercise - stop smoking Drugs - lipid lowering/statins - treating hypertension if present - strict diabetic control - long acting nitrates if necessary - antiplatelet drugs surgical interventions
33
What are some surgical interventions for IHD
- Angiography - Coronary angioplasty +/- insertion of a stent - Coronary artery bypass grafting (CABG)
34
What are some dental considerations for angina pectoris
- if stable, can be safely managed in outpatient dental setting - if unstable, best treated for dental emergencies only, this being in a hospital setting - Coronary angioplasty pts and CABG pts may be on anticoagulant medications - Consider antibiotic prophylaxis if dental treatment needed within 6 months of post intervention
35
Describe unstable angina
- rapidly worsening angina - symptoms occur at rest-no exertion - may be a sign of impending myocardial infarction
36
What does myocardial infarction imply and what are its symptoms?
- death of heart muscle - severe tightening chest pain - dyspnoea - cold sweat - nausea - unexplained weakness - pt looks 'grey'
37
What to do in the dental setting if myocardial infarction occurs
- stop all procedures - call for help - keep pt semi-supine or upright - stay calm and keep pt calm - emergency tx (MONAH) morphine, oxygen, nitrates, aspirin, heparin - monitor vital signs - urgent transfer to hospital setting
38
How is GTN used in myocardial infarction?
sublingually, every 5mins if necessary
39
how is oxygen used in myocardial infarction?
if pt is dyspnoeic, low sats, or in shock
40
How is aspirin used in myocardial infarction?
300mg
41
What are some conditions that myocardial infarction can lead to?
- Fatal arrythmias - shock - cardiac rupture - pericarditis - DVT/PE - heart failure and therefore cardiac arrest, death
42
What are some dental considerations for post MI patients
- pt may be on antiplatelets - risk of 2nd occurence (decreases with time) - try to avoid interventions for 6 weeks - only essential procedures for 6 months
43
What to do if deciding to treat MI patient
- Consult pt GP or cardiologist - Discuss risks and benefits - Discuss drug interventions - Consider/discuss stress relief protocols - Good anaesthetic technique - Short appts. - Chair positioning - Consistent monitoring
44
Describe atrial fibrillation
- Very common - Chaotic, irregular atrial rhythm - irregular pulse
45
What does atrial fibrillation increase risk of?
- embolic stroke - palpitations - chest pain - drops in cardiac output-dyspnoea and fainting
46
What are some dental considerations for arrythmias
- May be precipitated by stress/LA administration - patients often on therapeautic anticoagulation - may be on a cardiac pacemaker
47
Describe heart failure
- chronic syndrome due to weakened pumping action of the heart - diminished cardiac output - fluid accumulation in the venous and pulmonary circulation - Leads to reduced exercise tolerance
48
What are the 3 types of heart failure
- Right ventricle failure - Left ventricle failure - Complete heart failure
49
Describe classification of heart failure
- Grade I: no limitation of activities - Grade II: no limitation under resting conditions - Grade III: limitation on mild exertion - Grade IV: limitation of activities at rest, restricting person to bed or chair
50
What are common causes of heart failure?
- Heart muscle disease eg. cardiomyopathy or coronary artery disease - Chronic excessive after-load eg HTN, cor-pulmonale - Structural defects leading to reverse shunting/hyperdynamic circulation - Inadequate heartrate
51
What are symptoms of right ventricular failure
- peripheral oedema - pitting oedema of lower limbs - ascites (fluid in abdominal cavity) - hepatomegaly (enlarged liver)
52
What are symptoms of left ventricular failure
- pulmonary oedema-main feature - shortness of breath-exertional - orthopnoea - wheeze - cough - haemoptysis - fatigue
53
How is heart failure treated?
- treat underlying conditions - restrict salt and alcohol - drug therapy (diuretics, ACE inhibitors, anticoagulants, nitrates, digoxin)
54
What are some dental considerations for heart failure patients?
- cannot lie flat - may have a troublesome cough - postural hypotension - diuretics - may need restricted use of LA containing vasoconstrictors - May be on therapeutic anticoagulants
55
What is infective endocarditis
a potentially fatal infection that affects the endocardium, usually in valvular, mural, and septal defects
56
What are symptoms of infective endocarditis
- fatigue - fever - headache - joint inflammation or pain - night sweats - poor appetite and/or weight loss - rash
57
What cardiac conditions need antibiotic cover?
- prosthetic valves - prev. endocarditis - rheumatic valvular heart disease - unrepaired cyanotic congenital heart disease - surgical catheter repair of congenital heart disease within 6 months of repair procedure
58
What to do if pt has chest pain and/or SOB
angina or MI? - call 111 - oxygen - Try GTN spray: 2 puffs sublingual every 5mins - monitor vital signs
59
What to do if pt suddenly collapses/loses consciousness
cardiac arrest? - call 111 - DRSABC - CPR - Crash trolley: early defibrillation

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