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Oral Medicine > Caring for the patient with cardiac disease > Flashcards

Caring for the patient with cardiac disease Flashcards

1
Q

Atheroslerosis aka Atherosclerotic Heart Disease (ASHD)

A
  • coronary artery disease leads to infarction
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2
Q

Congestive Heart Failure (CHF)
(2)

A
  • dilated ventricles with weak muscles
  • thickened myocardium
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3
Q

Valvular disease
(3)

A
  • stenotic and not capable of full closure for blood circulation
  • lack of tonicity also leads to stenosis
  • leads to CHF
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4
Q

Caring for the patient with cardiac disease
layman presentation
coronary artery -
heart valve -
congenital heart -
arrhythmia -
heart failure -
heart muscle -

A

arteries that supply oxygen and blood to the heart become narrow
one or more of the valves in the heart are not working well
children may with this disease
abnormal heart rhythm
heart does not have enough strength to pump
heart walls become thick or heart becomes enlarged

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5
Q

Caring for the patient with cardiac
disease
Symptoms
(10)

A
  • General weakness
  • Fatigue
  • Light headedness
  • Dizziness
  • Fainting
  • Shortness of breath with mild exertion
  • Chest pain
  • Palpitations
  • Hypertension
  • Edema of the legs and ankles
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6
Q

CVD Risk Factors
conditions (5)

A

HBP
high cholesterol
diabetes
rheumatic fever
>1 CVD

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7
Q

HBP (2)

A
  • Stiffens vessels which reduces blood flow
  • also a risk for stroke, kidney disease and dementia
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8
Q

high cholesterol

A

LDLs

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9
Q

diabetes

A

unstable glucose levels affect myocardium fnx; angiopathy

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10
Q

CVD Risk factors
behavioral (6)

A

unhealthy diet - Carbs, fats, caffeine, 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, etc
stress

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11
Q

family hx (3)

A

genetics
becoming older
ethnicity

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12
Q

Atherosclerotic plaques can lead to:
(2)

A
  • ischemia
  • thrombosis, (vascular blockage) if they
    rupture
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13
Q

Atherosclerosis
* Can affect arteries of:
(5)

A

➢ Heart
➢ Aorta
➢ Brain
➢ Kidney
➢ Peripheral arteries

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14
Q

Atherosclerosis
may not
may be

A

progress
asymptomatic - Plaques themselves do not
usually produce symptoms

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15
Q

skipped
Dental Procedure Categories
type 1

A

exams, radiographs, oral hygiene instructions, study model impressions

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16
Q

skipped
Dental Procedure Categories
type 2

A

simple operative dentistry, ortho

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17
Q

skipped
Dental Procedure Categories
type 3

A

adv operative dentistry, SRP, endo

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18
Q

skipped
Dental Procedure Categories
type 4

A

simple extractions, curettage/gingivoplasty

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19
Q

skipped
Dental Procedure Categories
type 5

A

multiple extractions,
flap surgery or gingivectomy,
extraction of single bony impaction,
apicoectomy,
single implant placement

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20
Q

skipped
Dental Procedure Categories
type 6

A

full arch/full mouth extractions or flap surgery,
extraction of multiple bony impactions,
orthognathic surgery,
multiple implant palcement

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21
Q

Low Level Intervention
(6)

A
  • Health/medical evaluation
  • Exams
  • Prophy
  • Radiographs
  • Optical oral scans
  • Alginate impressions
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22
Q

Moderate Intervention
(4)

A
  • SRP (scaling and root planning)
  • Simple restorative procedures; 1-2 teeth
  • Simple extractions; 1-2 teeth
  • Restorative impressions needing retractions
    and longer setting times
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23
Q

High Risk Intervention
(6)

A
  • Complex restorative procedures on >2 teeth
  • Multiple extractions
  • Surgical extractions
  • Implant placement
  • Full arch impressions
  • Dental care under general anesthesia
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24
Q

time of procedure is proportional to

A

risk category

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25
Q

The less the symptoms
and the better the
control of risk factors
THEN

A
  • the better a patient
    manages the stress
    AND
  • the less likely the
    patient will have a life
    threatening incident
    during a dental
    procedure
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26
Q

The greater the symptoms
and the poorer the
control of risk factors
THEN

A
  • the worse a patient
    manages the stress
    AND
    the more likely the patient
    will have a life threatening
    incident during a dental
    procedure
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27
Q

Hypertension (HTN):
- ?
- Depending on location of flow, it damages endothelium which leads to
(2)
- Same issue of altered flow creating risk for (3)

A

Stiffens vessels which reduces blood flow
clotting disorders and more infarct risk
stroke, kidney disease and
dementia

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28
Q

Hypertension
Increases Risk for:
(7)

A
  • Myocardial infarction
  • Stroke
  • Coronary artery disease
  • Peripheral artery disease
  • Heart failure
  • Retinopathy
  • End-stage renal disease
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29
Q

normal bp

A

<120 and <80

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30
Q

elevated bp

A

120-129 and <80

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31
Q

HTN stage 1

A

130-139 or 80-89

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32
Q

HTN stage 2

A

> 140 or >90

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33
Q

HTN stage 3

A

> 180 and/or >120

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34
Q

Blood Pressure
 NO dental care at UMKSC SOD if BP
➢ – is classified as a Hypertensive Urgency by the AHA based on
2017 guidelines
➢ Urgent referral →
➢ If patient is symptomatic →

A

≥ 180/110 mmHg
180/120
see doctor ASAP
Emergency Room

35
Q

ACE inhibitors (3)

A

angioedema
neutropennia/agranulocytosis
taste disturbances

36
Q

anti-arrythmics, class 1
sodium channel blockers
(3)

A

dry mouth
gingival ovoerrowth
hypersensitivity reaction syndrome

37
Q

ca channel blockers

A

gingival overgrowth, dry mouth, taste disturbances

38
Q

diurects
(1)

A

dry mouth

39
Q

Hypertension
Oral Manifestations
None due to hypertension itself
* Side-effects of pharmacotherapy:
(7)

A

➢ Dry mouth (anti-adrenergics and diuretics)
➢ Burning mouth (ACEi)
➢ Taste changes (antiadrenergics, ACEi)
➢ Angioedema (ACEi, ARB)
➢ Gingival hyperplasia (calcium-channel blockers, what are the other 2?)
➢ Lichenoid reactions (thiazides, methyldopa, propranolol, and labetalol)
➢ Lupus-like lesions (hydralazine)

40
Q

Gingival Hyperplasia – a side-effect of pharmacotherapy:
(2)

A

➢ amlodipine (Norvasc) a CA channel blocker – anti-HTN; less common side
effect, BUT…
➢ nifedipine (Adalat) a CA channel blocker

marked edema

41
Q

Gingival Hyperplasia – a side-effect of pharmacotherapy:
➢ — anti-epileptic – occurs in 50% of patients on this medication
➢ ethosuximide (Zarontin) – anti-epileptic
➢ lamotrigine (Lamictal) – anti-epileptic
➢ phenobarbitone (Luminal) – anti-epileptic
➢ primidone (Mysoline) - – anti-epileptic
➢ topiramate (Topamax)
➢ vigabatrin (Sabril)

A

Phenytoin

42
Q

Gingival Hyperplasia – a side-effect of pharmacotherapy:
➢ Cyclosporins (an immune suppressor –

A

anti-graft rejection; less common
side effect, BUT.. marked edema

43
Q

Gingival Hyperplasia – Treatment (5)

A

➢ Modify medication with a consultation to the prescribing physician
(cardiologist, neurologist, etc
➢ Laser excision with scaling and curretage
➢ Electrosurgery – excise overgrowth tissue with control of hemorrhage
➢ Gingivectomy - excise affected tissue and reduce with sutures.
➢ Periodontal flap surgery – scale teeth and curettage of inflamed tissues with
flap access tp affected tissues

44
Q

Gingival Fibromatosis

A

● generalized or localized increases in the volume of
gingiva

45
Q

Gingival Fibromatosis
manifests with the onset of

A

eruption of the
permanent or primary teeth, or with the eruption of
primary teeth

46
Q

Gingival Fibromatosis
may occur as
(3)

A
  • an isolated feature
  • part of a syndrome
  • medication related
47
Q

Hypertension
Medical Management
* Lifestyle modifications
(3)

A

➢ Diet (increase fruit intake, decrease sodium, increased potassium)
➢ Physical exercise/weight loss
➢ Tobacco cessation and alcohol intake reduction

48
Q

Angina Pectoris
* Chest pain resultant from ischemic changes
➢ Mid-chest pain described as

A

o “aching, heavy squeezing pressure or tightness”

49
Q

Angina Pectoris
Pain may radiate

A

➢ Shoulder, arms, jaw

50
Q

Angina Pectoris
Pain lasts

A

5-15 minutes
➢ If unstable angina, may be longer

51
Q

Angina Pectoris
— used to resolve angina

A

Vasodilation

52
Q

Stable
➢ Imbalanced —
➢ Stable symptoms, (3)
➢ Chest pain precipitated by —
➢ Resolves with —
➢ Responds to —

A

cardiac perfusion
reproducible, predictable, consistent
physical activity/exertion
cessation of activity
nitroglycerin

53
Q

Unstable
➢ Disruption of —
➢ Possible (3)
➢ Symptoms —
➢ Chest pain at —

A

atherosclerotic plaque
partial thrombosis, embolism or vasospasm
increasing
rest or with less intense physical activity/exertion

54
Q

Congestive Heart Failure (CHF)
(2)

A
  • dilated ventricles with weak muscles
  • thickened myocardium
55
Q

CHF
Symptoms
(10)

A

General weakness
Fatigue
Shortness of breath with mild exertion
Light headedness
Dizziness
Fainting
Chest pain
Palpitations
Hypertension
Edema of the legs and ankles

56
Q

Valvular Disease
(2)

A
  • Compromised function of the heart valves
  • Valves direct blood flow into different heart chambers
57
Q
  • Valves direct blood flow into different heart chambers
    (2)
A

➢ Atrioventricular:
o Tricuspid and Mitral
➢ Semilunar
o Aortic and Pulmonary

58
Q

Valvular Disease
* Valves open and close
~

A

100,000/QD

59
Q

Valvular Stenosis

A

➢ Do not open properly

60
Q

Valvular Insufficiency
(2)

A

➢ Do not close properly
➢ Associated with regurgitation

61
Q

Valvular Heart Disease
Risk Factors (other)
(3)

A
  • Calcifications
  • Congenital defects (bicuspid aortic valve, mitral valve prolapse)
  • Infections
62
Q

Valvular Heart Disease
Signs
(4)

A

➢ Murmurs
➢ Syncope
➢ Heart failure
➢ Shortness of breath

63
Q

Valvular Heart Disease
Symptoms
(3)

A

➢ Heart failure
➢ Exercise intolerance
➢ Shortness of breath (can also be a symptom)

64
Q

Valvular Heart Disease
Medical Management
(2)

A
  • Treatment is primarily surgical
  • Valve replacement (more common)
65
Q

Valve replacement (more common)
➢ Mechanical Implants
(2)

A

o Silicone
o Requires long-term anticoagulation

66
Q

Valve replacement (more common)
➢ Bioprosthetic Implants
(3)

A

o Allograft , bovine graft, etc.; decellularized CT
with a less antigenic structural matrix
o short-term anticoagulation
o Long-term antiplatelet therapy)

67
Q

Valvular Heart Disease
Predisposition for

A

infective endocarditis

68
Q

Valvular Heart Disease
Dental Considerations
(4)

A
  • Assess ability to tolerate care in context of underlying condition and
    comorbidities
  • Assess Bleeding Risk
  • Infections
  • Drug Effects
69
Q

VHD
* Infections
➢ Determine need for

A

antibiotic prophylaxis and antibiotic of choice

70
Q

VHD
* Assess Bleeding Risk
(2)

A

➢ Obtain INR the day of the invasive procedures
➢ Have local hemostatic measures in place

71
Q

VHD
Drug Effects
➢ Review medication list
(2)

A

o Drug adverse effects
o Drug-drug interactions

72
Q

prophylatic abx are generally recommended only for

A

high risk category

73
Q

High Risk-
(5)

A

Mechanical prosthetic heart valve
Natural prosthetic heart valve
Prior infective endocardititis
Valve repair with prosthetic material
Most congenital heart diseases
akers/ defibrillators

74
Q

Moderate Risk-:
(4)

A

Valve repair without prosthetic material
Hypertrophic cardiomyopathy
Mitral valve prolapse with regurgitation
Acquired valvular dysfunction

75
Q

Low Risk-
(4)

A

Innocent heart murmurs
Mitral valve prolapse without regurgitation
Coronary artery disease
People with pacem

76
Q

Infective Endocarditis
Conditions that DO NOT require Antibiotic Prophylaxis
(5)es

A
  • Heart murmur
  • Mitral valve prolapse
  • Mitral valve prolapse with regurgitation
  • Rheumatic fever
  • Stent or coronary artery bypass graft (cabg)
77
Q
  • Note: If a heart murmur is due to specific cardiac condition (e.g., previous
    endocarditis, prosthetic heart valve, complex congenital cyanotic heart
    disease), AHA continues to recommend
A

antibiotic prophylaxis for most
dental procedur

78
Q

Infective Endocarditis
Procedures that DO NOT require Antibiotic Prophylaxis
(4)

A
  • Radiographs
  • Placement of appliances
  • Routine local injections
  • Tooth shedding or trauma
79
Q

Infective Endocarditis
Procedures that DO NOT require Antibiotic Prophylaxis
* Radiographs
* Placement of appliances
* Routine local injections
* Tooth shedding or trauma
These procedures are unlikely to:
(3)

A
  1. Manipulate the gingival tissue
    2.Manipulate the periapex of teeth
    3.Perforate the oral mucosa
80
Q

Antibiotic prophylaxis is recommended for
ONLY AT RISK PATIENTS who have
procedures that:
(3)

A
  1. Manipulate the gingival tissue
    2.Manipulate the periapex of teeth
    3.Perforate the oral mucosa
81
Q

OBS.: If the dosage of antibiotic is
inadvertently not administered before the
procedure, the dosage may be administered up
to — after the procedure.

A

2 hours

82
Q

Infective Endocarditis
Patients already taking antibiotics
If a patient is taking a beta-lactam (penicillin, amoxicillin, etc.) for an
active, existing infection resistant strains have likely been selected
* If urgent/emergency dental treatment is necessary
➢ Prescribe

A

azithromycin or clarithromycin (i.e., macrolides)

83
Q

IE
* If dental treatment is elective

A

➢ Wait 10 days after completion of the antibiotic for their
active infection, then prescribe amoxicillin according to
AHA guidelines
Infective Endocarditis

84
Q
A

Oral Medicine (13 decks)

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