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Flashcards in Chronic CV Diseases Deck (27)
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What is the aetiology of hypertension?

No causes (essential hypertension), rare causes (renal artery stenosis, endocrine tumours)


What are the signs and symptoms of hypertension?

usually none, may get TIAs, may get headaches


What are the investigations for hypertension?

urinalysis, serum biochemistry, serum lipids, ECG, renal ultrasound/angiography, hormone estimations


What are the treatment options for hypertension?

modify risk factors, single daily drug dose (thiazide diuretic, ACE inhibitor, beta blocker, calcium channel antagonist)


What are the different types of heart failure and what are their aetiology?

high output failure = anaemia, thyrotoxicosis
low output failure = cardiac defect e.g. MI, heart valve disease
left/right heart failure, congestive heart failure


What are the signs and symptoms for heart failure?

left heart failure = lung and systolic effects (dyspnoea, tachycardia, low BP, low vol. pulse)
right heart failure = venous pressure elevated (swollen ankles, ascites, rasied JVP, enlarged tender liver, poor GI absorption)


What are the treatment options for heart failure?

acute (emergency hosptial management - oxygen, frusemide, morphine)
chronic (community based - treat any underlying cause, improve myocardial function, reduce compensation effects)
drugs (diuretics, ACE inhibitors, nitrates, inotropes)


Describe the ASA classifications.

ASA I = normal healthy patient
ASA II = patient with mild systemic disease e.g. smoker, obesity, well controlled hypertension/diabetes
ASA III = patient with severe systemic disease, not incapacitating e.g. poorly controlled hypertension, diabetes, distant history of MI/TIA/cardiac stent
ASA IV = patient with severe systemic disease that is a constant threat to life e.g. recent MI/TIA/cardiac stent
ASA V = a patient who is not expected to survive without an operation e.g. ruptured abdominal aneurysm
ASA VI = declared brain dead


How would undiagnosed atrial fibrillation be recognised when feeling a patients pulse?

irregular and random strength - fast, fluttering pulse


What are the differences between a metal prosthetic valve and a porcine valve?

metal prosthetic valves require anticoagulant use as blood clots around these
porcine valves do not


What does asystole look like on an ECG?

flat line


How does ventricular fibrillation look like on an ECG?

extremely irregular rhythm, absent P wave, no cardiac output
treat with defibrillation


What two heart valves are most commonly replaced?

Mitral and aortic valves


What causes heart valve disease?

congenital abnormality, myocardial infarction, rheumatic fever (does not always do this), dilatation of the aortic root


What are the implications for dental care of a patient who has a history of prosthetic valve replacement?

anticoagulant use, INR must be between 2 and 3 (normal=1), extraction must be packed with pressure and/or sutures, risk of endocarditis


Which patient groups are at risk of infective endocarditis from an oral bacteraemia?

previous endocarditis, valve replacement, structural congenital heart disease, hypertrophic cardiomyopathy


Describe what each segment represents on a normal sinus rhythm ECG.

P wave = atrial depolarisation
QRS wave = ventricular depolarisation
T wave = ventricular repolarisation


Describe angina.

Reversible ischaemia of the heart muscle
Caused by narrowing of one or more coronary arteries


What are classical angina symptoms and signs?

No pain at rest
Pain with certain level of exertion - worse with cold weather/emotion
Pain relieved at rest
Central crushing chest pain - may radiate to arm, back, jaw
Often no signs
Occasionally hyperdynamic circulation (anaemia, hyperthyroidism, hypovolaemia)


What are the investigations for angina?

ECG - resting and exercise
Eliminate other disease
Isotope studies (function assessment)


What are the treatment options for angina?

Reduce oxygen demands of heart (reduce afterload, reduce preload)
Increase oxygen delivery to tissues
Dilate blocked/narrowed vessels - angioplasty
Bypass blocked/narrowed vessels - CABG (coronary artery bypass grafting)
Modify risk factors
Reduce MI risk - aspirin
Hypertension - diuretics, Ca channel antagonists, ACE inhibitors, B blockers
Reduce preload/dilate vessels - nitrates
Emergency - GTN spray


How is a MI usually caused?

Atheroma in vessels - ulcerated plaque with platelet aggregates, thrombosis on surface
Thrombosis can enlarge rapidly to block vessel
Plaque surface/platelets detach - travel and block vessels, no blood flow to that area -> infarction


What is hypertension?

Increased BP systolic >140mmHg, diastolic >90mmHg


What are pacemakers used for and what are their dental implications?

used to treat bradyarrhythmias, maintain minimum heart rate, sensitive to electromagnetic fields (avoid use of ultrasonic scalers and electrosurgery units)


What are the signs and symptoms of a myocardial infarction?

Pain, nausea, sweaty, 'going to die', silent MI (no symptoms or misleading symptoms eg heartburn)


What are the investigations for MI?

Cardiac enzyme levels


What are the treatment options for MI?

Hospital, analgesia, aspirin, reassurance, basic life support of required, thrombolysis if indicated, acute angioplasty and stenting if available
Prevent next MI - risk modification, aspirin, B blocker, ACE inhibitor
Treat complications - heart failure, arrhythmias, psychological stress