LO1 (ischemic heart disease)

Atherosclerosis

A thickening of the intimal layer of the arterial wall. Caused by accumulation of lipid plaques. Results in narrowed arterial lumen with diminished blood flow and oxygen supply. Most common underlying cause of coronary heart disease, angina and myocardial infarction (M.I.) cerebrovascular disease (stroke), and peripheral arterial disease (intermittent claudication).

Ischemic heart disease

Symptoms are the result of oxygen deprivation secondary to reduce blood flow to a portion of the mycardium. Other condition such as embolism, coronary ostial stenosis, coronary artery spasm, and congenital abnormalities also may cause ————— ———— —————.

2-8

Clients with diabetes have a — to — times higher rate for future cardiovascular event.

Hyperglycemia

Patients with ———————— have a greater degree of atherosclerosis in the major arteries and micro vascular circulation. Insulin resistance promotes atherosclerosis even before it produces frank diabetes. Insulin resistance is an independent risk factor for atherothrombosis.

Metabolic syndrome

A syndrome that describes a cluster of pathological findings: obesity, insulin resistance, low HDL cholesterol, elevated triglycerides, and hypertension.

Inflammatory disorder

The current understanding of atherosclerosis is that it is an ———————— disorder of the cellular lining of the arteries, with inflammation playing a fundamental role at all stages of the disease.

75%

Ischemic symptoms may be produced when occlusion reaches ——% of the cross-sectional area of the artery.

Plaque rupture

The fibrous cap tears, allowing arterial blood to enter the lipid core. Induces platelet adhesion. Can result in the thrombus formation. Blood flow through the affected artery may become compromised or completely blocked. This is called a:

Stable angina

Pain that is predictably reproducible, unchanging, and consistent over time. Typically is precipitated by physical effort such as walking or climbing chairs. May occur with eating or stress. Pain is relieved by cessation of the precipitating activity, by rest, or with the use of nitroglycerin.

Unstable angina

This is defined as: new onset pain, pain that is increasing in frequency, pain that is increasing in intensity, pain that is precipitated by less effort than before, or pain that occurs at rest. This pain is not relieved by nitroglycerin. The key feature is the changing character (increasing intensity) or pattern of the pain.

Unstable

Patients with this type of angina have a poorer prognosis and often experience an acute MI within a short time.

Recent MI (within the past 7-30 days) and unstable angina

These 2 conditions are clinical predictors of major risk for perioperative complications.

Past history of ischemic heart disease (stable angina and past history of MI)

This is considered one of the intermediate risk factors for perioperative complications.

3.5 or less

Patients who are taking warfarin for anticoagulation can safely undergo dental or surgical procedures, provided that the INR is —.— or less.