Management of the cardiac patient

Question 1

In hypertension what stage usually has no contraindication to ambulatory oral surgery?

Answer 1

-Mild to moderate

Question 2

What is the systolic and diastolic range in mild to moderate hypertension?

Answer 2

• Systolic < 200

- Diastolic < 110

Question 3

What is the systolic and diastolic range in severe hypertension?

Answer 3

• Systolic > 200

- Diastolic > 110

Question 4

What do you do if someone has severe hypertension

Answer 4

-Postpone until pressure is better controlled

Question 5

If someone is in mild to moderate hypertension what should you do with treatment?

Answer 5

-You can do treatment

Question 6

If someone has an acute hypertensive event with SYMPTOMS what is that known as?

Answer 6

-Hypertensive emergency

Question 7

What are some symptoms with a hypertensive emergency?

Answer 7

• Dizzy

- Faint

Question 8

What are the key principles with Ischemic heart disease?

Answer 8

• Mismatch in myocardial oxygen demand and oxygen supply

- Angina is a symptom of ischemic heart disease

Question 9

Who does Ischemic heart disease occur in?

Answer 9

• Men over 40

- Post menopausal women

Question 10

What drug do you give if someone has angina?

Answer 10

-Nitroglycerin

Question 11

What does nitroglycerin do?

Answer 11

• Venodilation (more than vasodilation)
• Vasodilation
• Decreases the demand on the heart because it diminishes the preload

Question 12

How many carpules can you give at most to a patient with angina?

Answer 12

-2 carps every 30 minutes

Question 13

What is what Metabolic equivalent defined as?

Answer 13

-3.5 mL O2 uptake/kg per min

Question 14

If a person answers yes to getting chest pain after walking one city block or a flight of stairs what does that mean?

Answer 14

-They have poor functional capacity

Question 15

What is the line of MET’s for poor function capacity?

Answer 15

< 4 MET

Question 16

What is a Myocardial infarction?

Answer 16

-Results when an oxygen supply-demand mismatch results in myocardial cell/death/ dysfunction

Question 17

What is the difference between angina and myocardial infarction?

Answer 17

-Myocardial infarction is associated with cell death

Question 18

If a person has a myocardial infarction history how long should it be until dental treatment elective surgeries are performed?

Answer 18

6 months

Question 19

Dual antiplatelet therapy is recommended for how long following PCI (Percutaneous intervention) and stenting procedures?

Answer 19

-12 months

Question 20

What drugs are they one if doing DAPT?

Answer 20

• Aspirin (platelets)
• Plavix (platelets)
• Coumadin (vitamin K dependent)
• Xabans

Question 21

What is common in patients with history of ischemic heart disease?

Answer 21

-Cardiac Dysrhythmias

Question 22

What is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body’s needs known as?

Answer 22

-Heart Failure

Question 23

What are some of they symptoms of congestive heart failure?

Answer 23

• Shortness of breath (due to fluid build up in the lungs)

- Coughing

Question 24

What should you do if someone has congestive heart failure?

Answer 24

-Defer treatment until heart function has been medically improved an the physician believes treatment is possible

Question 25

What are Cerebrovascular accidents?

Answer 25

-Strokes

Question 26

What are the two types of strokes?

Answer 26

- Hemorrhagic | - Ischemic

Question 27

Which type of stroke deals with a clogged artery?

Answer 27

-Ischemic

Question 28

If a patient has had a Cerebrovascular accident (CVA) what are they at further risk for?

Answer 28

-More CVAs

Question 29

If a person has had a CVA and you take their blood pressure and it appears hypertensive what should you do?

Answer 29

-Defer treatment

Question 30

What is infective endocardititis?

Answer 30

-An infection of the heart chambers or valves

Question 31

What bacteria is a common cause of IE?

Answer 31

-Streptococcus viridans

Question 32

What are the four guidelines if someone has IE that need a prophylaxis treatment?

Answer 32

- Prothetic cardiac valve - Previous IE - Congenital Heart Disease - Cardiac transplant

Question 33

What is the most common antibiotic for IE prophylaxis?

Answer 33

-Amoxicillin

Question 34

If a person is allergic to penicillin what antibiotic should you use for IE prophylaxis?

Answer 34

-Clindamycin

Question 35

What amount of amoxicillin should you provide to someone who has IE?

Answer 35

- 2 g 30-60 minutes prior to procedure (adults) | - 50 mg/kg in children

Question 36

What amount of clindamycin should you provide to someone who has IE?

Answer 36

- 600 mg (adults) | - 20 mg/kg

Question 37

If patients have a mechanical valve are they anti-coagulated? If so for how long?

Answer 37

-Yes and for life

Question 38

What are the four Vitamin K dependent factors?

Answer 38

- II - VII - IX - X

Question 39

What is a normal INR (International normalized ratio)?

Answer 39

1

Question 40

What do you need to know if somebody is on coumadin?

Answer 40

-INR #

Question 41

What is another name for Coumadin?

Answer 41

-Warfarin

Question 42

MONA stands for what? Use this for someone who begins having severe chest pain

Answer 42

- Morphine - Oxygen - Nitroglyercine (sublingual) - Aspirin