Angia pectoris (CAD)

No limitations or ordinary physical activity, excerise tolerance 7-8 METs. angina only occurs with strenuous exercise (ASA II)

CCS class I angina pectoral

Slight limitation or ordinary activity, exercise tolerance 5-6 MET. Angina occurs with walking more than 2 blocks or climbing more than 1 flight of stairs at normal pace. May also occur when moving faster, in the cold, or waking up in the morning for a few hrs (ASA III)

CCS class II angina pectoris

Marked limitation of ordinary physical activity, exercise tolerance 3-4 METs. Angina occurs when walking 1-2 blocks or climbing 1 flight of stairs at normal place. (ASA IV)

CCS class III of angina pectoris

Inability to perform any physical activity without discomfort, angina may also be present at rest. Exercise tolerance 1-2 METs (ASA IV)

CCS class IV angina pectoris

Pain/discomfort brought on by exertion. Relived by rest or nitroglycerin. Last less that 15-20 secs. Tightness, elephant of chest, indigestion, Levine sign (fist over chest), radiate to back, jaw, and left arm

Symptoms or stable angina

Last longer than 20 mins, severe pain, occur at rest

Symptoms for unstable angina

Diet/exercise, avoid stress, medication, and revascularization,

Management of stable angina

Nitrates, beta blockers, calcium channel blockers, and anti platelet agents

What medications are used of angina pectoris

EKG, nuclear technetium 99M myocardial perfusion test, catheterization, CAT scans, and MRI with dye

What is used to diagnose angina pectoris

Test shows where ischemia is occurring due to MI from months ago (glowing donut)

What is a nuclear technetium 99M perfusion test

Angioplasty with stem or coronary artery bypass grafting

What types of revascularization can be performed for angina pectoris

All stents are thrombogenic and requires use of anti platelet drugs (worse in drug eluting stent)

What is a concern when using angioplasty with stent

Saphenous vein from leg or mammary artery from chest (less likely to become atherosclerotic)

What vessels are used for coronary artery bypass grafting (CABG)

ASA II or III

What ASA classification is stable angina

ASA IV

What ASA classification if unstable angina

Short morning appointments, low stress, oral sedation or nitrous, nitroglycerin on hand, profound anesthesia achieved, limit vasoconstrictor, effective post op pain control

What is dental treatment for stable angina

Makes patient more sensitive to L.A. containing vasoconstrictors and should be limited to 3 carpule of 2% lidocaine or switch to selective beta blocker

What is the concern with non selective beta blockers

Elective care postponed, emergency treatment performed in hospital to monitor and give prophylactic nitroglycerin

What is the dental management for unstable angina

No, risk of post op bleeding is low

Does a patient with angina who takes less than or equal to 325mg of aspirin a day have to stop usage

Assess INR, if greater than or equal to 3.5, they have moderate/high risk of bleeding and should as PCP to reduce dose

What is angina patient is on warfarin

NO need to adjust dose, likely to have delayed by good hemostasis

If angina patient is taking direct acting oral anticoagulants such as drugs ending in “ban/tran (Xarelto or Eliquis) what needs to be done

NSAIDs

What drug should not be used if patient is on warfarin or direct acting anticoagulant