PME ch 11: medical conditions involving the cardiovascular system

cardiovascular disease (CVD)

-can be congenital or acquired

-blood vessel related

-hypertension (silent killer)

-heart related

types of blood vessel related CVD

-aneurysm

-coronary artery disease

aneurysm

thin walls/ ballooning/ rupure

types of coronary artery disease

-atherosclerosis

-arteriosclerosis

atherosclerosis

inner walls of arteries build up fatty deposits called plaque

arteriosclerosis

the thickening and hardening of arteries as you age

types of heart related CVD

-angina pectoris

-arrhythmias

arrhythmias

heart rate of rhythm is irregular or abnormal

CVD can lead to:

-heart failure

-myocardial infarction (heart attack)

-stroke

risk factors for CVD

-Smoking

-Family history of CVD

-Diabetes mellitus

-High cholesterol

-High blood pressure

-Obesity

-Sedentary lifestyle

angina pectoris

Pain in chest from lack of oxygenation of muscle tissue

angina is associated with

-Atherosclerosis & inability of vessels to dilate

-Diversion of blood flow after heavy meal

symptoms of angina

Cramping, suffocating, pain, pressure

types of angina

-stable

-variant

-unstable

stable angina

-caused by physical excretion

-lasts 1-15 minutes

-subsides with rest

variant angina

-sudden spasm

-temporarily stops blood flow to part of the heart

-occurs at rest

-cold/hyperventilation/induces spasm

unstable angina

-acute coronary syndrome —>up to 30 minutes —>MI

-Severe obstructive CVD

-Greatest risk adverse problem = unpredictable and MI

application to practice for angina

-Nitroglycerin sublingual tablets

-Maximum of 3 in 10 minutes

stress reduction protocol for angina

-Keep appointments short

-Keep appointment on time to reduce anxiety

-Use adequate measures to prevent pain

-Consider use of pretreatment antianxiety medication

• Valium

• Xanax

management of client with angina

-Reposition to upright

-Reassure client, maintain composure to ↓ anxiety

-Measure & record blood pressure (BP) & pulse (after each dose)

• Deviations from normal

• Regularity of pulse

-If systolic BP <100 mm Hg, no more sublingual nitroglycerin

• Vasodilating action = loss of blood pressure

-Provide 100% oxygen

-Call 911 if pain not relieved in 10 minutes (5)

-Record events of emergency in dental record

conditions of valvular heart disease

-Damaged heat valves

-Congenital heart defects

-Heart murmur

-Mitral valve prolapse

-Rheumatic heart disease

conditions at risk for infective endocarditis

-congenital

• Unrepaired, repaired 6 mo., repaired w/residual defects. Shunt = yes

-artificial heart valve

• Prosthetic cardiac valve replacement

  • Anticoagulant

application to practice for valvular heart disease

-Non-valvular devices:

• No pre-med for Stents, Patches, and Vascular grafts

-Consult client’s physician prior to oral procedures

• Cardiac transplant

• Congenital

-For artificial heart valve:

• Anticoagulant meds

• Use digital pressure to stop bleeding

• Use Hemostatic rinse

signs of cardiovascular stress

-Perspiration

-Nausea

-Shortness of breath

-Pressure in chest

management of cardiovascular stress

-Perform basic life support

• Open airway

• Breathing and circulation are adequate

-Provide 100% oxygen as needed

-Call 911 if not resolved

heart failure (HF)

-Clinical syndrome characterized by:

• Dyspnea (shortness of breath)

• Fatigue

• Edema

HF results in

-Reduced output of oxygenated blood

-Right ventricular failure

-left ventricular failure

right ventricular failure

-happens second

-Edema in lower extremities

-Diuretics

-Worsen = cyanosis of lips/nail beds = EOIO

left ventricular failure

-happens first

-Fluid in lung (congestive)

• Orthopnea (supine/difficult breathing)

• Back elevated to breath

-↓ Kidney function

class A of HF

-Risk for HF

-ex: HBP, CAD, DM, Alcohol Abuse

class B of HF

-Structural heart disease

-Developing HF; not progressed

-Mild symptoms

-Fatigue, palpations, dyspnea w/ normal active

-Comfort at rest

class C of HF

-Structural heart disease

-Marked limitations

-↑ Symptoms of HF

-Uncomfortable at rest

class D of HF

-Advanced structural

-Advanced disease

-Symptoms of HF even at rest despite therapies

-Mild activity = ↑ symptoms

treatment for classes A and B of HF

elective dental care is fine

treatment of class C of HF

-medical consult required

-hospital setting may be required for oral care

treatment for class D of HF

-no elective treatment

-emergency treatment in hospital setting

general treatment for clients with HF

-Monitor vital signs

• Pulse

• Breathing

-Observe respiration sounds

-Semi-upright position

• Helps them breath

-Stress reduction protocol

-Supplemental oxygen

-Nitrous oxide

• Non-symptomatic

symptoms of acute pulmonary edema in a client with HF

-Dry cough

-Wheezing

-Suffocation & anxiety

-Increased respiration rate

-Hyperventilation

management of acute pulmonary edema in a client with HF

-Call 911

-Place in upright position

-Provide basic life support

-Provide 100% oxygen

-Monitor vital signs every 5 minutes & record

-Stress reduction protocol

-Sublingual nitroglycerin (given by dentist)

myocardial infarction (MI)

Lack of oxygenated blood supply to heart (ischemia)

MI is caused by

-Atherosclerosis

-Vasospasm

-Thrombotic blockage

-may Result in death of heart muscle tissue

management of client with history of MI

-No elective oral treatment within 6 months after MI

-Medical clearance for stressful procedures

-Evaluate functional capacity (4 MET)

-Determine risk for future MIs

-Anticoagulant medication

symptoms of acute MI

-Squeezing in chest

-Pain in chest

-Pain radiating to arms, neck, back, or jaw

-Difficulty breathing

-Perspiration

-Nausea

-Possible vomiting

-Hypertension

-Feel very uncomfortable (Impending doom)

management of acute MI in dental office

-Place in upright position

-If symptoms unrelieved, call 911

-Sublingual nitroglycerin (given by dentist) only 3 in 10 minutes

-Provide 100% oxygen

-Monitor vital signs

-Have client chew 325-mg aspirin tablet

• Crush aspirin/give with water

-Provide basic life support & be prepared for CPR

blood pressure

Force against which heart must pump to perfuse body with blood

systolic

pressure in blood vessels when heart contracts and pumps blood

diastolic

pressure in the vascular system when the heart is filling

hypertension

-≥140/90 mm Hg

-Smoking, overweight, high cholesterol, diabetes

-Increased risk for MI, HF, stroke, renal failure, atherosclerosis

hypotension

-Caused by blood loss or vasodilating medications

-Can lead to fainting

-Shock

symptoms of acute CVA

-Severe headache

-Visual abnormalities

-Confusion

-Slurred speech

-Inability to speak

-Numbness

-Losing feeling on one side

management of acute CVA in dental office

-Place client in comfortable position, head elevated

-Ask client to:

• Smile

• Raise both arms

• Speak a simple sentence

• Stick out tongue

-Call 911

-Provide basic life support

-No elective oral treatment within 6 months after CVA

transient ischemic attack (TIA)

-Mini stroke

-Blood vessel disturbance

-Usually recovers in 10 minutes

-Immediate treatment to prevent stroke

-Having a TIA is a strong predictor for having a stroke w/in 6 mos

-Patient having a few to several = increased likelihood for stroke

-delay dental treatment for 6 months

reversible ischemic neurologic deficit (RIND)

-Does not clear up w/in 24 hours but recovery does occur

-Unilateral numbness of face and extremities

-Speech problems but do resolve w/in an hour

-delay dental treatment for 6 months

pacemaker or implanted cardiac device

-Past not used with US scalers

-Now not a concern “shielded”

headache

-Bruxism

-TMJ issues

migraines

-Vascular headache

-Poorly understood but several theories

-Women more prone

-Personality type (overachievers)

-Sleeping/eating habits

-↓ caffeine intake/food allergies

-Emotional stress