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Oral Medicine and Diagnosis > Caring for the Cardiac Pt > Flashcards

Caring for the Cardiac Pt Flashcards

(85 cards)

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1
Q

what is the most common cause of premature death in the world

A

cardiovascular disease

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2
Q

what are the types of CVD disease

A
  • HTN
  • atherosclerosis
  • CAD
  • CHF
  • arrhythmias
  • bacterial endocarditis
  • angina pectoris
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3
Q

pts frequently have _____ CVD

A

more than one

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4
Q

CVDs are:

A

interrelated

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5
Q

CAD leads to:

A

infarction

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6
Q

what is bacterial endocarditis characterized by

A
  • infection
  • inflammation
  • scarring
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7
Q

what is CHF associated with

A

-dilated ventricles with weak muscles
- thickened myocardium

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8
Q

what is valvular heart disease characterized by

A

-stenotic and not capable of full closure for blood circulation
-leads to CHF

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9
Q

what are the conditions that are CVD risk factors

A
  • high BP
  • high cholesterol
  • diabetes
  • rheumatic fever
  • more than 1 CVD
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10
Q

why is high BP a risk factor

A

stiffens vessels which reduces blood flow

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11
Q

why is high cholesterol a risk factor

A

a risk for stroke, kidney disease, and dementia

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12
Q

why is diabetes a risk factor

A

unstable glucose levels affect healthy myocardium function, angiopathy

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13
Q

what are the behavioral risk factors

A
  • unhealthy diet: carbs, caffeine, fats, Na+
  • physical inactivity: poor circulation
  • obesity- excess weight stresses heart function, HTN, CAD
  • too much alcohol- increases BP, arrythmias
  • tobacco use; increases HR, BP, CAD
  • stress
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14
Q

what are the family hx risk factors

A
  • genetics
  • becoming older
  • ethnicity
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15
Q

what are the contributary anatomic abnormalities in CVD

A
  • hypertrophy
  • dilation
  • valves
  • regurgitation
  • stenosis
  • vascular
  • heart structure
  • rhythm
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16
Q

what are the physiologic changes in CVD

A
  • arrhythmias
  • heart failure
  • ischemia
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17
Q

what are the signs of CVD

A
  • elevated BP
  • irregular or abnormal HR
  • abnormal respiratory rate
  • shortness of breath upon exertion
  • prolonged bleeding/easy bruising
  • surgical scars
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18
Q

what are the symptoms of CVD

A
  • patient is uncomfortable in supine position
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19
Q

what are the physical activity questions you should ask your patient

A

-do you feel shortness of breath at rest
- are you physically active?
- what kind of activities do you engage in?
- do you feel shortness of breath after exercise
- does it limit the intensity of your physical activity

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20
Q

what are the hypertension history questions you should ask the pt

A
  • how long have you had high BP
  • who manages your BP, primary care or cardiologist?
  • how long have you been on this current antihypertenisve regimen?
  • have there been any recent changes to your BP meds? Why?
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21
Q

what are the HTN monitoring questions you should ask

A
  • what is your usual BP at the doctors office
  • do you check your BP at home
  • what are your usual readings, how high does it get>
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22
Q

what are the management strategies for pt with HTN

A

check BP - 3 readings at 5-10 min intervals- 2 automatic and 1 annual

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23
Q

what are the 2 things that you would do with diagnosed HTN- being treated

A
  • elevated: 120-129/ less than 80: proceed with tx
  • greater than or equal to stage 1: 130-180/greater than 120: med consult -> within BP goal proceed with tx with cardiac measures OR BP goal unmet no dental tx
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24
Q

what is the protocol for undiagnosed HTN

A
  • elevated: proceed with tx but recommend med eval
  • greater than or equal to stage 1: no dental tx until med eval
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25
what BP should pt be referred to emergency room
SBP greater than 180 and/or DBP greater than 120
26
what is normal bp
- systolic: less than 120 AND - diastolic: less than 80
27
what is elevated BP
- systolic: 120-129 AND - diastolic: less than 80
28
what is high blood pressure stage 1
-systolic: 130-139 OR - diastolic: 80-89
29
what is high blood pressure stage 2
- systolic: 140 or higher OR - diastolic: 90 or higher
30
what is hypertensive crisis
- systolic: higher than 180 and/or - diastolic: higher than 120
31
how many readings do you need to dx HTN
greater than or equal to 2 readings on greater than or equal to 2 separate visits
32
the less the symptoms and the better the control of risk factors then:
- the better a pt manages the stress - the less likely the pt will have a life threatening incident during a dental procedure - and vice versa
33
what are the low level interventions
- health/med eval - exams - prophy - radiographs - optical oral scans - alginate impressions
34
what are the moderate interventions
- SRP - simple restorative procedures: 1-2 teeth - simple extractions: 1-2 teeth - restorative impressions needing retractions and longer setting times
35
what are the high risk interventions
- complex restorative procedures on greater than 2 teeth - multiple extractinos - surgical extractions - implant placement - full arch impressions - dental care under general anesthesia
36
time of procedure correlates to:
risk category
37
what is atherosclerosis
- inflammatory disorder with accumulation of lipid plaque within the arterial walls - thickened intima (decreased arterial lumen) - decreased oxygen - decreased blood flow to the myocardium
38
what does athersclerosis lead to
- stenosis - angina (stable ischemic disease) - MI - ischemic stroke (acute ischemic disease) - peripheral arterial disease
39
what are the risk factors for atherosclerosis
- male sex - age - smoking - lack of exercise - obesity - stress - DEPLETION - FAM HX OF CVD - hyperlipidemia - high LDL - HTN - INSUIN RESISTANCE - DM
40
athersclerotic plaques can lead to:
- ischemia - thrombosis (vascular blockage) if they rupture
41
what are the steps in atherosclerosis
- chronic endothelial injury: HDL, HTN, smoking, monocysteine, hemodynamic factors, toxins, viruses, immune reactions - endothelial dysfunction: increased permeability, leukocyte adhesion, monocyte adhesion, and emigration - smooth muscle emigration from media to intima, macrophage activation - macrophages and smooth muscle cells engulf lipid - smooth muscle proliferation, collagen and other extracellular matrix deposition
42
what are the symptoms of atherosclerosis
- chest pain - angina
43
what are the complications of atherosclerosis
- unstable angina - MI - necrosis - thrombosis - embolism - aneurysm
44
what does the RAA system do
maintains physiologic BP when BP is low
45
what does AT1 do
- smooth muscle cell contraction - systemic vasoconstriction - increased vascular resistance - aldosterone release - sodium reabsorption - decreased renal medullary blood flow - increased BP
46
what does AT2 do
- antiproliferative effects - natriuresis - vasodilation - decreased BP - pilocarpine (salagen)
47
what is the RAA system pathway
- angiotensinogen -> renin -> angiotensin I -> ACE -> angiotensin II -> ACE2 -> angiotensin 1-7
48
what causes the release of renin
- decreased sodium delivery - decreased renal afferent perfusion pressure - increased renal sympathetic activity - increased vasodilation
49
what releases angiotensinogen
liver
50
what releases renin
kidney
51
what releases ACE
lung
52
what does Angiotensin II act on
adrenal gland and vessels
53
what does aldosterone act on
kidney
54
what are the complications of HTN
- CAD - heart failure - MI - stroke - Peripheral artery disease - retinopathy - end stage renal disease
55
BP is determined by:
indirect measurement in the upper extremities with a BP cuff and stethoscope
56
cuff should encompass ____ of the circumference of the arm
80%
57
center of cuff over:
brachial artery
58
cuff too small ->
falsely elevated values
59
white coat HTN ->
elevates BP by 30mmHg
60
pregnant pts increase systolic BP by:
greater than or equal to 10mmHg
61
why is HTN in pregnant pts concerning
risk of eclampsia
62
where should the proper arm position be when taking BP
horizontal at heart level - mid sternum
63
arm below heart level ->
over estimates systolic and diastolic pressures
64
arm above heart level ->
under estimates systolic and diastolic pressures
65
what are the HTN goals usually
less than 130-149/ 80-90 mmHg
66
no dental care at UMKC if BP is:
greater than or equal to 180/110
67
what is classified as a hypertensive urgency
180/120
68
what do you do if pt blood pressure is greater than or equal to 180/120
urgent referral to see doctor ASAP or if symptoms are present go to ER
69
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
70
what are the SE of ACE inhibitors
- angioedema - neutropenia/agranulocytosis - taste disturbances
71
what are the SE of sodium channel blockers
- dry mouth - gingival overgrowth - hypersensitivity reaction syndrome
72
what are the SE of calcium channel blockers
- gingival overgrowth - dry mouth - taste disturbances
73
what are the SE or diuretics
dry mouth
74
what are the SE of alpha adrenergic blockers
dry mouth
75
what are the SE of beta adrenergic blockers
dry mouth, angioedema
76
what are the oral manifestations of HTN meds
- dry mouth - alpha adrenergics and diuretics - burning mouth (ACE) - taste changes (Antiadrenergics, ACEi) - angioedema (ACEi, ARB) - gingival hyperplasia (calcium channel blockers and other 2 - lichenoid reactions (thiazides, methyldopa, propranolol, labetalol -lupus like lesions ( hydralazine)
77
what are the oral manifestations of HTN
none - only due to meds
78
what are the dental considerations for the HTN Pt
- serious potential complications of severe uncontrolled HTN: - stroke - angina - arrhythmia - MI
79
what may increase Pt BP
stress, anxiety, fear
80
what should you consider for pts taking nonselective beta blockers
use of vasocontrictors can cause an acute risk in BP
81
pts may be sensitve to sudden position changes causing:
orthostatic hypotension
82
whatt are the pre operative considerations for the HTN pt
- reduce stress and anxiety - may need oral and/or inhalation sedation
83
what are the intra operative considerations for the HTN pt
- profound anesthesia (most important) - limit epi to 2 carpules if taking a selective beta blocker- 2 carp rule - dont use Epi gingival retraction cord
84
what are the post operative considerations for the HTN pt
- avoid macrolide ABs with calcium channel blocker: increases CCB levels - avoid long term use of NSAIDs ( more than 2 weeks) - stage 2, monitor BP during tx if 180/110 stop tx - raise pt slowly after tx bc of hypotension
85

Oral Medicine and Diagnosis (12 decks)

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