Intro to Cardiovascular Disease

Question 1

What is hypertension?

Answer 1

Persistently high blood pressure >140/90mmHg

Question 2

What drugs are taken by patients with hypertension and what do they do?

Answer 2

Aspirin - anti-platelet drug

Captopril - ACE inhibitor

Atenolol - b1-blocker

Candesartan - angiotensin II receptor blocker

Nifedipine - calcium ion channel blocker

Bendroflumethiazide - diuretic

Question 3

What are the possible primary causes of hypertension?

Answer 3

Genetic

Environmental - obesity, alcoholism, salt intake, stress

Question 4

What are the possible secondary causes of hypertension?

Answer 4

Renal disease

Pregnancy

Endocrine disease

Drugs

Coarctation of aorta

Question 5

How is hypertension diagnosed?

Answer 5

3 occasions over a 3 month period (consistently) at least

Question 6

How are the primary causes of hypertension treated?

Answer 6

(General advice)

Weight loss

Increased exercise

Reduce alcohol intake

Stop smoking

Reduce salt intake

Question 7

What are the complications of hypertension?

Answer 7

Heart failure

Stroke (cerebrovascular accident/CVA)

Coronary artery disease/myocardial infarction

Renal failure

Peripheral vascular disease

Question 8

What is considered severe hypertension?

Answer 8

> 180/110mmHg

Question 9

How is hypertension relevant in dentistry?

Answer 9

Minimise stress and pain to prevent further increase in blood pressure

No problem with adrenaline in local anaesthetic (as long as no intravascular injection)

Controlled hypertension = treat as normal

Uncontrolled hypertension = delay treatment and refer to a GP

Severe hypertension = refer urgently to hospital

More likely to have post-operative bleeding

Likely to be taking aspirin

Question 10

What are the oral manifestations of drugs used to treat hypertension?

Answer 10

ACE inhibitors = loss of taste, angioedema, lichenoid reactions

b-blockers = lichenoid reactions

Calcium ion channel blockers = gingival overgrowth

Diuretics = xerostomia

K+ channel activators = oral ulceration

Question 11

What is xerostomia?

Answer 11

Dry mouth

Question 12

What does haemostasis require?

Answer 12

Vasoconstriction

Platelet plug

Coagulation

Question 13

What additional measures can be taken to achieve haemostasis?

Answer 13

Extra pressure

Minimise trauma

Sutures

Haemostatic material in sockets

Post-operative instructions

Question 14

What drug is used to treat hypercholesterolaemia?

Answer 14

Simvastatin

Question 15

What are the risk factors of deep vein thrombosis?

Answer 15

Immobility

Surgery

Obesity

Pregnancy

OCP

Smoking

Question 16

What is the international normalised ratio?

Answer 16

How long it takes for blood to form a clot (therefore determines effect of an oral anticoagulant)

Question 17

What is the typical INR for DVT?

Answer 17

2-3

Question 18

What is syncope?

Answer 18

Fainting

Question 19

Why must you lay a fainted patient flat?

Answer 19

So blood can reach brain otherwise fitting will occur

Question 20

How can you avoid patient syncope?

Answer 20

Extra reassurance and time

Ensure patient has eaten before procedure (glucose drinks)

Question 21

What may cause syncope in a dental setting?

Answer 21

Stress, pain, fear

Question 22

What is/causes postural hypotension?

Answer 22

Posture change (sitting to standing) causes blood to pool in lower limbs

Sudden drop in blood pressure

Question 23

In which types of patient is postural hypotension common?

Answer 23

Elderly

Those taking antihypertensive medication

Question 24

How can you avoid postural hypotension in dentistry?

Answer 24

Sit patient up slowly from lying down

Verbal cues

Question 25

What is ischaemic heart disease?

Answer 25

Term given to heart problems caused by narrowed coronary arteries

Question 26

What is myocardial infarction?

Answer 26

Death of the muscle cells of a blocked coronary artery as insufficient oxygenated blood supply

Question 27

What is angina?

Answer 27

The crushing chest pain caused by insufficient oxygenated blood reaching the heart

Question 28

What is the aetiology of IHD?

Answer 28

Atheromatous plaque within coronary arteries constrict blood flow

Question 29

What can rupturing of the atheromatous plaque in IHD cause?

Answer 29

Acute thrombi Myocardial infarction

Question 30

What are the modifiable risk factors for IHD?

Answer 30

Hyperlipidaemia, obesity, lack of exercise, diabetes Smoking, high alcohol intake, OCP Stress, hypertension

Question 31

How can angina be relieved?

Answer 31

Rest Glyceryl trinitrate/GTN/nitroglycerin

Question 32

What is unstable angina?

Answer 32

Angina that increases rapidly in severity and occurs at rest

Question 33

What can provoke angina?

Answer 33

Exercise Emotion

Question 34

What drugs can be used in the treatment of angina?

Answer 34

GTN/nitrates b-blockers Calcium ion channel blockers K+ ion channel blockers

Question 35

How can angina be treated surgically?

Answer 35

Angioplasty (stent insertion) Coronary artery bypass graft

Question 36

What are the symptoms of myocardial infarction?

Answer 36

Severe crushing chest pain >15mins Shortness of breath Nausea and vomiting Paleness Sweating Tachycardia

Question 37

What is tachycardia?

Answer 37

Very high heart rate

Question 38

What is brachycardie?

Answer 38

Very low heart rate

Question 39

What is the relevance of IHD in dentistry?

Answer 39

Stress and pain may trigger angina or MI May present as jaw pain Patient may be using GTN and/or aspirin Unstable angina = delay treatment until controlled

Question 40

What is an example of a K+ channel activator?

Answer 40

Nicorandil