Heart Failure, Infective Endocarditis, and Valvular diseases

Question 1

Which ventricle of the heart typically fails first?

Answer 1

Left Vent

Question 2

How is the size of heart and effectiveness of the heart changed in heart failure?

Answer 2

Increase in size with decrease in effectiveness

Question 3

_____ can measure the degree of heart failure

-Measures amount (%) of blood that leaves the left ventricle after contraction

Answer 3

Ejection Fraction

Question 4

What is the Ejection Fraction (%) range that is considered normal?

Answer 4

55-70%

Question 5

How is ejection fraction calculated?

Answer 5

[Blood volume pumped out/ blood volume in chamber] x 100

Question 6

If the ejection fraction is between 41-49%, what does it say about extent of heart failure?

Answer 6

Borderline HF: warning signs

Question 7

If EF is less than ___%, it signifies that HF is likely

Answer 7

Less than 40%

Question 8

Signs of \_\_\_\_\_\_\_
➢Rapid, shallow breathing
➢Inspiratory rales (crackles)
➢Increased heart rate
➢Distended jugular (neck) veins
➢Peripheral edema
➢Ascites
➢Cyanosis
➢Weight gain
➢Clubbing of fingers

Answer 8

Heart Failure

Question 9

Symptoms of \_\_\_\_\_\_
➢Fatigue and weakness
➢Orthopnea 
(dyspnea in recumbent position)
➢Exercise intolerance
➢Muscular fatigue
➢Feeling heavy 
(weight gain)
➢GI distress 
(nausea, vomiting & constipation)

Answer 9

heart Failure

Question 10

What are the 2 forms of drugs that are administered for pts with heart failure?

Answer 10

ACE inhibitors

Beta blockers

Question 11

What is used as an intermediate therapy for heart failure?

Answer 11

LVAD

Question 12

Based on study given in class, can dental treatment occur prior to cardiac surgery?

Answer 12

Yes

Question 13

In most cases of HF, the dentist will need to obtain a ________ with the patient’s cardiologist to determine
• The patient’s physical status
• Laboratory test results
• Level of control
• Compliance with medications and recommendations
• Overall stability

Answer 13

medical

consultation

Question 14

Heart failure classification where routine dental care is ok?

Answer 14

Class 1

Question 15

Heart failure classification where routine dental care is likely ok with a med consult?

Answer 15

Cllass 2

Question 16

Heart failure classifications where routine dental should consider to refer to specialized care?

Answer 16

3 &4

Question 17

How should the chair be positioned in a pt with heart failure?

Answer 17

Slightly reclined; pt likely can’t handle supine chair position

Question 18

If patient taking _______
➢Epinephrine should be avoided, if possible
➢Combination increases the risk for arrhythmia

Answer 18

digitalis glycoside (digoxin) –positive inotrope

Question 19

If patient taking digitalis glycoside (digoxin) –positive inotrope
➢Epinephrine should be ________
➢Combination increases the risk for arrhythmia

Answer 19

avoided, if possible

Question 20

• Compromised function of the heart valves

Answer 20

Valvular disease

Question 21

➢ Do not open properly

Answer 21

Valvular Stenosis

Question 22

➢ Do not close properly

➢ Associated with regurgitation

Answer 22

Valvular Insufficiency

Question 23

➢ Stiff, sclerosis, stenosis causing either stenosis or insufficency

Answer 23

Fibrosis

Question 24

➢ Benign loose CT tumorous changes where valves become Floppy, prolapse, regurgitation
➢ Causes insufficiency

Answer 24

Myxomatous degeneration

Question 25

``` Signs of ______: ➢ Murmurs ➢ Syncope ➢ Heart failure ➢ Shortness of breath ```

Answer 25

Valvular disease

Question 26

Symptoms or ______: ➢ Heart failure ➢ Exercise intolerance ➢ Shortness of breath (can also be a symptom)

Answer 26

Valvular disease

Question 27

What is the treatment for valvular disease?

Answer 27

Surgical

Question 28

Valvular disease/ surgical valves are a predisposition for

Answer 28

Infectious endocarditis

Question 29

Most pts on valvular disease are on what types of meds?

Answer 29

Blood thiinners

Question 30

If the pt had a mechanical prosthetic valve, what type of meds are they on?

Answer 30

Anti clotting

Question 31

If pt has a bioprosthetic valve, what type of meds are they on?

Answer 31

Anti-platelet

Question 32

If pt has valvular disease, is a med consult needed?

Answer 32

All needed

Question 33

Infection of the inner later of the heart that usually affects cardiac valves Was almost fatal until the development of peniicillin 15,000 cases diagnosed in US each year

Answer 33

infective Endocarditis

Question 34

________: precipitated by bacterial/ fungal infection; potential death from emboli and valvular disturbance - Blood turbulence within heart allows causative agent to infect previously damaged valves or other endothelial surfaces

Answer 34

Endocarditis

Question 35

_____: caused by bacteremia | - Caused by damaged endothelium affecting blood flow leading to infection

Answer 35

Infective endocarditis

Question 36

The following are indications for ______: - Mechanical prosthetic heart valve - Natural prosthetic heart valve - Prior IE - Valve repair with prosthetic material - Most congenital heart diseases

Answer 36

ABX prophylaxis

Question 37

Antibiotic prophylaxis is recommended for ONLY AT RISK PATIENTS who have procedures that do what 3 things?

Answer 37

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

Question 38

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

Answer 38

2 hours

Question 39

What are some of the abx that are used in IE?

Answer 39

Amoxicillin Clindamycin Ampicillin Azithromycin

Question 40

- If a patient is taking a beta-lactam (penicillin, amoxicillin, etc.) for an active, existing infection and, - If urgent/emergency dental treatment is necessary ➢ Prescribe ______ or _______

Answer 40

azithromycin or clarithromycin

Question 41

• If dental treatment is elective ➢ Wait ___ days after completion of the antibiotic for their active infection, then prescribe ______ according to AHA guidelines

Answer 41

10 days; amoxicillin

Question 42

Conditions that do or do not require Antibiotic Prophylaxis • Heart murmur • Mitral valve prolapse • Mitral valve prolapse with regurgitation • Rheumatic fever • Stent or coronary artery bypass graft (cabg)

Answer 42

DO NOT

Question 43

``` Procedures that do or do not require Antibiotic Prophylaxis • Radiographs • Placement of appliances • Routine local injections • Tooth shedding or trauma ```

Answer 43

DO NOT

Question 44

_____ or ______ is a predictor of IE chances

Answer 44

Size of bacteremia or bacteria number

Question 45

Are most bacteremias caused by dentistry or everyday activities?

Answer 45

Everyday activities