Heart Surgery & Devices

Question 1

what are some common cardiac surgery and devices?

Answer 1

• stents
• CABG
• pacers
• defibrillators
• valves

Question 2

re-stenosis rate and return of syms of pts who had balloon angioplasty?

Answer 2

w/in 6 mos for 10-50% of pts

Question 3

re-stenosis rate of pts who had balloon angioplasty with placement of stent?

Answer 3

reduced re-stenosis to 20-30%

Question 4

types of coronary artery stents

Answer 4

1. bare metal
2. drug-eluting
3. bioresorbable

Question 5

drug-eluting stent

Answer 5

metal stent coated with a polymer containing anti-proliferative agents that inhibit re-stenosis

Question 6

which type of stent has an increased risk of thrombosis for 1 year after placement?

Answer 6

drug-eluting stent

Question 7

should pts w stents placed be given antibiotic prophylaxis?

Answer 7

no but check with cardiologist if recently placed (<1 month)

Question 8

pts with stents placed are taking what type of drugs?

Answer 8

• Aspirin and clopidogrel

- dual antiplatelet therapy

Question 9

should pts with stents discontinue taking their aintiplatelet drugs before their dental appt?

Answer 9

no

Question 10

how long should you wait before treating pt post-stent placement?

Answer 10

at least a month

Question 11

what is the underlying disease process for CABG?

Answer 11

coronary artery disease

Question 12

do pts with CABG need antibiotic prophylaxis?

Answer 12

no

Question 13

pts with CABG are on what type of drugs?

Answer 13

• dual antiplatelet therapy (DAPT)

- aspirin and clopidogrel

Question 14

should pts with CABG discontinue their medications before their dental appointment?

Answer 14

NO

Question 15

implantable pacemaker is for what heart condition?

Answer 15

bradycardia

Question 16

how does an implantable pacemaker work?

Answer 16

if SA node not functioning properly (ie not sending out beat at regular pace) so pacemaker will fill in when SA node falls behind

Question 17

implantable cardioverter-defibrillator (ICD) is for what heart condition?

Answer 17

ventricular tachycardia

Question 18

electromagnetic interference of pacemaker or ICD

Answer 18

• detects extraneous signal and misinterprets them

- can cause rate alterations, sensing abnormalities, asynchronous pacing, reprogramming

Question 19

do pts with implanted cardiac devices need antibiotic prophylaxis?

Answer 19

no

Question 20

cause of valvular disease

Answer 20

• scarring of myocardial tissues (MI)
• overwork of leaflets (HTN)
• calcium deposits causing thickening of leaflets (age)
• infections (IE)

Question 21

which valves are most commonly involved in valvular disease?

Answer 21

aortic and mitral valves

Question 22

prolapse valve

Answer 22

blood coming from atrium to ventricle is getting shoved back into atrium

Question 23

do aortic valves get prolapsed?

Answer 23

no, they’re not designed like mitral valves

Question 24

stenosis of valve

Answer 24

• opening narrowed so blood doesn’t exit heart as it should

- leads to heart failure

Question 25

regurgitation of valves

Answer 25

blood squirting back into atrium

Question 26

progression of valvular disease

Answer 26

- blood backs up into pulmonary vasculature - blood backs up in systemic vasculature - heart failure

Question 27

diagnosis of valvular disease

Answer 27

- signs/symptoms of heart failure - cardiac auscultation for murmurs - detection of murmur will prompt further investigation

Question 28

echocardiogram

Answer 28

- used for definitive diagnosis of valvular disease - ultrasound of heart showing size & shape of heart, anatomic abnormalities - how well chambers and valves are working

Question 29

treatment of valvular heart disease

Answer 29

- goal=optimize system to keep disease from progressing - close physician follow-up to catch before it progresses to pulmonary hypertension and heart failure - valve replacement

Question 30

mechanical replacement valves

Answer 30

- made of strong, durable materials and last longer than other types of replacement valves - most will last throughout pt's entire lifetime

Question 31

how long do pts with mechanical replacement valves have to take anticoagulant drugs for?

Answer 31

lifetime

Question 32

how long do pts with mechanical replacement valves have to take antibiotic prophylaxis drugs for?

Answer 32

lifetime

Question 33

bioprosthetic replacement valves

Answer 33

made from animal valves or other animal tissues that's strong and flexible - may last 10-20 years

Question 34

how long do pts with bioprosthetic replacement valves have to take anticoagulant drugs for?

Answer 34

temporarily (~3 months usually until suture lines are healed)

Question 35

how long do pts with bioprosthetic replacement valves have to take antibiotic prophylaxis drugs for?

Answer 35

lifetime

Question 36

normal INR

Answer 36

0.8-1

Question 37

INR goal for pts with valvular heart disease

Answer 37

2-3

Question 38

severe valvular disease is considered what type of risk?

Answer 38

major