Cardiovascular Disorders

Front 1

Atherosclerosis
Define

Back 1

Atherosclerosis
- disease of the arteries
- Plaque formation in the tunica intima

Front 2

Atherosclerosis
Risk factors:

Back 2

Atherosclerosis
Risk factors:
– Male
– Increased age
– Family history of atherosclerosis (AD)
– Diabetes
– Hypertension
– Hypercholesterolemia
– Smoking
– Sedentary lifestyle
– Stress

Front 3

Atherosclerosis can lead to ...

Back 3

May lead to aneurysms or infarction

Front 4

Aneurysms

Back 4

An aneurysm is a bulge or "ballooning" in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body. If an aneurysm grows large, it can burst and cause dangerous bleeding or even death.

Front 5

Infarction

Back 5

Infarction is the formation of an infarct, that is, an area of tissue death (necrosis) due to a local lack of oxygen caused by obstruction of the tissue's blood supply.

Front 6

Abdominal Aortal Aneurysm
Define:

Back 6

Abdominal Aortal Aneurysm
Localized weakness and bulging of a
vessel wall.

Front 7

Abdominal Aortal Aneurysm is associated with which genetic disorder?

Back 7

CT disorders like:
– Marfan syndrome
– Ehlers-­‐Danlos syndrome
– Some infections

Front 8

Abdominal Aortal Aneurysm
Prognosis?

Back 8

Abdominal Aortal Aneurysm
Poor, if untreated and large.

Front 9

Raynaud’s disease/phenomenon
Define:

Back 9

Raynaud’s disease/phenomenon
• Lack of oxygen to tips of fingers/toes/ears/nose.
• can be linked to trauma such as forstbite of carpal tunnel (DH)

Front 10

Raynaud’s disease/phenomenon
Treatment?

Back 10

Raynaud’s disease/phenomenon
No treatment for mild cases or vasodilators (calcium channel blocker) for severe cases.

Front 11

Raynaud’s disease/phenomenon
Symptoms?

Back 11

Raynaud’s disease/phenomenon
- color change in affected tissue from normal to pale and then cyanotic
- numbness & tingling

Front 12

Thrombus

Back 12

Blood clott

Front 13

Embolus

Back 13

Embolus
Blood clott that became detached that moves that moves with the circulation of blood flow

Front 14

Thromboembolic venous disorders

Back 14

Thromboembolic venous disorders
- Thrombi (blood clott) that forms in the deep vein of the legs

Front 15

Thromboembolic venous disorders
What happens with the thrombus?

Back 15

- thrombus breaks away from epithelium and becomes an embolus that find its way through the pulmonary circulation and lodges in the lung

Front 16

Thromboembolic venous disorders
Symptoms?

Back 16

- in legs mostly asymptotic if small
- if symptoms then deep muscle pain and swelling in the DISTAL area of clot

Front 17

Thromboembolic venous disorders
Symptoms when it get to the lungs?
pulmonary embolism?

Back 17

- can cause ischemia and can become necrotic
if large can impair lung function --> hypertension and sudden death

Front 18

Thromboembolic venous disorders
Dental Implication?

Back 18

Thromboembolic venous disorders Anti-coagulent therapy increases risk of uncontrolled bleeding

Front 19

Box 8.1
Factors associated with the development of deep venous thrombosis
STASIS
(what may cause it?)

Back 19

STASIS
- heart failure
- venous obstruction
- immobility due to bed rest, paralysis
- Myocardial infraction (heart attac)

Front 20

Factors associated with the development of deep venous thrombosis
HYPERCOAGULATION

Back 20

HYPERCOAGULATION
- Oral contraceptive
- pregnancy
- childbirth
- stress
- cancer

Front 21

Factors associated with the development of deep venous thrombosis
VASCULAR TRAUMA

Back 21

VASCULAR TRAUMA
- severe accidental trauma
- surgical trauma
- severe infection

Front 22

What are the INR for clotting time?

Back 22

INR
Expressed from 1-10
3 or less is safe for treatment

Front 23

Which medication should be avoided when treating anticoagulated pt.?

Back 23

Increase prothrombin time (decreases clot formation)
- Aspirin
- other nonsteroidal antiinflamatory medication
- tetracycline
- erythromycin
- clarithromycin
- metronidazole

Decrease prothrombin time (increase of clot formation)
- Penicillin

Front 24

Hypertension

Back 24

Hypertension
primary = cause unknown / 95%
secondary= sequela of another disease / 5%

Front 25

Hypertensive people are at risk for what kind of diseases?

Back 25

- High blood pressure has side effects in most systems --> risk factor for developing almost all cardiovascular diseases and disorders, kidney disease, stroke and thrombo- hemolytic disorders

Front 26

Hypertension
Symptoms?

Back 26

Hypertension
Symptoms?
- asymptomatic
- if severe: headaches, dizziness, nose bleeding, visual disturbance

Front 27

Hypertension
Dental Implication?

Back 27

Hypertension
Dental Implication?
- xerostomia
- orthostatic hypotention
- local anesthetic containg epinephrine should be avoided

Front 28

Orthostatic Hypotention
Define:

Back 28

Orthostatic Hypotention
decrease in blood pressure upon rising from a supine position

Front 29

Normal BP

Back 29

<120 / <80

Front 30

Pre-hypertension

Back 30

Pre-hypertension
120-139 / 80-89

Front 31

Hypertention Stage 1

Back 31

Hypertension Stage 1
140-159 / 90-99

Front 32

Hypertension Stage 2

Back 32

Hypertension Stage 2
>160 / >100

Front 33

Most common cause of death in hypertensive people?

Back 33

Cause of death?
Congestive Heart Failure

Front 34

Stroke (cerebral vascular accident)
Define:

Back 34

Stroke (cerebral vascular accident)
- Lack of oxygen to brain
- Patients loose motor skills in side
opposite to stroke side

Front 35

Stroke (cerebral vascular accident)
Ischemic?

Back 35

Stroke (cerebral vascular accident)
Ischemic (Infraction) – due to embolism
- Clot stops blood supply to an are of the brain
- most common (90%)

Front 36

Stroke (cerebral vascular accident)
Hemorrhagic?

Back 36

Stroke (cerebral vascular accident)
- Hemorrhagic – due to trauma, aneurysms, and hypertension-
- blood leaks into the brain

Front 37

What precedes ischemic stroke?

Back 37

Many times TIAs precede ischemic strokes
TIA Transient Ischemic Attack - temporary obstruction of cerebral artery--> resulting in temporary neurologic signs and symptoms

Front 38

What to do if pt has stroke in dental office?

Back 38

- keeping pt. upright
- oxygen
-monitoring vital signs
-thrombolytic drugs must be given within 3 hours of onset or not at all

Front 39

Congenital heart defects

Back 39

Congenital heart defects
- genetic heart problem
- related to mother's infection, illness, medication and age during pregnancy
- born with it

Front 40

Endocarditis for which prophylaxis with dental procedure are recommended

Back 40

1. prosthetic cardiac valve
2. previous infective endocarditis
3. Cardiac transplantation recipient who developed cardiac valvuloplasy

Front 41

Endocarditis for which prophylaxis with dental procedure are recommended
Congenital Heart Disease (CHD)

Back 41

4. Congenital Heart Disease
- unrepaired cyanotic CHD, including palliative shunts and conduits
- completely repaired congenital heart defect with prosthetic material or device during the first 6 months after procedure
- repaired CHD with residual defects at the side or adjacent to the side of a prosthetic patch or prosthetic device

Front 42

Dental procedure for which endocarditis prophylaxis is recommended

Back 42

All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of oral mucosa

Front 43

What is the most common congenital heat defect?

Back 43

What is the most common congenital heat defect?
Ventricular Septal Defect

Front 44

Mitral Valve Prolapse
Define:

Back 44

- abnormal CT component
- Super-­elastic mitral valve that bulges into Left Ventrical.
- May or may not have regurgitation (back flow in opposite direction)
- No longer required antibiotic
prophylaxis
- reduction of alcohol and coffee

Front 45

Rheumatic heart disease

Back 45

- Sequela of rheumatic fever
- > 5% of bacterial throat infections
end up in Rheumatic Fever and
Rheumatic heart disease in 4/10 of
RF patients.

Front 46

Rheumatic fever

Back 46

Rheumatic fever
- autoimmine reaction that follows a throat infection caused by beta- hemolytic streptococcus
- childhood diseases (age: 5-15)

Front 47

Rheumatic fever

Back 47

- Cross reaction of antibodies to bacteria and host tissues
– Usually heart valve damage results in murmur
– Heart muscle histologically develops “Aschoff body”
--> Aschoff bodies are nodules found in the hearts of individuals with rheumatic fever. They result from inflammation in the heart muscle and are characteristic of rheumatic heart disease.

Front 48

Carditis

Back 48

Carditis
-inflammation of heart

Front 49

Infective Endocarditis

Back 49

• Bacteremia and cardiac defects or IV drug abuse facilitate bacterial
adhesion to heart valves-
- vegetation destroys CT
- if becomes loss may travel to different organs like brain, kidney and lungs and cause an abscess

Front 50

Infective Endocarditis
Which Bacteria?

Back 50

- Staphylococcus, Streptococcus
- Gram Negative Bacilli, Yeast, and Fungi (drug abusers)

Front 51

Antibiotic prophylaxis

Back 51

Antibiotic prophylaxis
Oral: Amoxicillin (Adult: 2.0mg / Children: 50mg/kg)
Unable to take oral medi

Front 52

Congestive Heart Failure

Back 52

Congestive Heart Failure
Inability of heart to pump blood adequately with subsequent body edema

Front 53

What causes Congestive Heart Failure?

Back 53

What causes Congestive Heart Failure?
Many causes
Left sided failure = lung flooding and pulmonary edema as fluid cannot be pumped out to body
• Orthopnea and Dyspnea

Right sided failure = peripheral edema

Front 54

Congestive Heart Failure
Symptoms:

Back 54

Congestive Heart Failure
Symptoms:
- Lip cyanosis can be seen in either R of L sided Congestive Heart Failure. (CHF)
- Pitting edema (pressing in the tissue)

Front 55

Congestive Heart Failure
What to do in emergency situation?

Back 55

Congestive Heart Failure
What to do in emergency situation?
- Modify chair position if needed
- Consider oxygen supplementation

Front 56

Coronary heart disease
Define:

Back 56

Coronary heart disease
- When the oxygen demands of the myocardium are not met due to coronary artery inadequate perfusion
- blood flow through the coronary arteries to the heart is inadequate
- most common cause is atheroslerosis

Front 57

Coronary heart disease

Back 57

Coronary heart disease
2 types:
– Chronic ischemic heart disease
– Acute coronary syndrome

Front 58

Coronary heart disease
Chronic ischemic heart disease

Back 58

Coronary heart disease
Chronic ischemic heart disease can manifest with or without symptoms.
When ischemia is with symptoms it is called angina pectoris

Front 59

Coronary heart disease
Acute coronary syndrome

Back 59

Coronary heart disease
Acute coronary syndrome include unstable angina, myocardial infraction and sudden death

Front 60

Myocardial Infraction

Back 60

Myocardial Infraction
- actual death of myocardial cells due to prolonged lack of oxygen.

Front 61

Angina attack:

Back 61

Angina attack:
- in substernal area of chest
- crushing and suffocating pain
- may radiate o jaw or into arms

Front 62

Coronary heart disease
Dental Implication:

Back 62

Coronary heart disease
Dental Implication:
- DH should not be avoided until 6 months from acute MI

Front 63

Unstable Angina
Dental Implication:

Back 63

Unstable Angina
Dental Implication:
- stress reduction technique
- supplemental oxygen
- nitroglycerin should be always available

Front 64

Calcium Channel Blocker
Dental Implication:

Back 64

Calcium Channel Blocker
Dental Implication:
- dental hyperplasia