Introduction to the cardiovascular system

What do systemic and parallel mean in relation to the circulatory system? 

Systemic - blood flows in a set order (right ventricle to lungs to left atrium)
Parallel - blood can flow through many vascular beds

What is the name of the blood pressure in the vena cava near the right atrium?

Central venous pressure

What is pulse pressure?

The difference between systolic and diastolic pressure. 

What is axial streaming? 

Cells becoming aligned in the middle of the vessel as this is where the least drag and fastest flow is.

what is primary hypertension

• at what mmHg 

• what causes it

• when ur blood pressure is persistently raised - 140/90mm Hg

• can be caused by genetic 

• caused by environmental: 

1. obesity 

2. alcohol 

3. salt intake 

4. stress

what is secondary hypertension

• HBP that is caused by after certain scenarios 

1. renal disease

2. pregnancy 

3. endocrine disease

4. drugs 

5. coarctation of aorta ( narrowing the aorta)

how do we diagnose hypertension

• measure blood pressure atleast 3 tines over 3 months

what is the first form of treatement for hypertension

• weight loss 

• excersize 

• less alcohol

• stop smoking 

• less salt intake 

for secondary hypertension: treat the cause 

what is the second treatement for hypertension

medical treatment

A- ace inhibitors , angiotensin II receptor blockers 
B- Beta blockers 
C- calcium channel blockers
D- diuretics

what are complication that can come after hypertension if left untreated

1. heart failure

2. stroke AKA cerebrovascular accident (CVA)

3. coronary artery disease 

4. renal failure 

5. peripheral vasuclar disease 

6. myocardial infraction

how does hypertension affect dental treatement 

1. need to minimise pain as it could lead to an increase in BP

2. if they have controlled (medicated) hypertension treat as normotensive ( normal patient)

3. if they have uncontrolled( no medication) hypertension you cant do non urgent dental work 

4. if they have severe hypertension refer to hospital 

5. they might bleed more post operation, as they cant make blood lcots as fast as they take aspirin which thins the blood 

6. adrenaline is in LA so if its injected directly into the veins it could cause hypertension to increase so you should be carefull not to

what dental side effects does the medication for hypertension ACE ihibitors

• loss of taste 

• angiodema - swealling of lip and tongue 

• lichenoid reaction - white patches

what dental side effects does the medication for hypertension Beta blockers

lichenoid reactions

what dental side effects does the medication for hypertension Calcium channel blockers

gingival overgrowth 

what dental side effects does the medication for hypertension diuretics

xerostomia - dry mouth

what is haemostasis and what are the steps needed to do this

stopping bleeding from a blood vessel after injury (e.g tooth extraction) 

1. vasocinstriction - the blood vessel constricts directly after damage so less blood flow

2. platlet plug - platlet stick to the damage blood vessel making a plug  

3. coagulation - clotting factors are activated fibre mesh forms making a blood clot

how does aspirin affect haemostasis and what addition steps do dentist do to help haemostasis

aspirin ( an anti platlet) is a blood thinner so the patient will continue to bleed and no blood clot form 

1. minimise trauma 

2. sutures 

3. extra pressure

4. put haemostatic material into the socket which will help form clots 

5. give post op advice  

what does warfarin affect 

it is an oral anticoaglulant
stops blood clots from forming

historically how did dentist manage patient extraction if they where on warfin and why has it changed

• stop taking warfarin for 3 days before extraction

• it can lead to increase chance of deep vein thrombosis  which is a clot in the blood vessels that leads to swelling 

how do dentist manage surgical procedures with patients on warfarin

if their internation normalised ration (INR) - which is a measure of how long a blood takes to clot is more than 4 then the bleeding risk is too high and the extraction is delayed 

how to respond when a patient faints

• lay flat so feet higher than head 

• loosen clothen 

• usually recover within 2-3 minutes

• try to reasure dental anxiety as the main cause is stress

what is postural hypotension

• who does it commonly affect 

• how to reduce it from happening

• low blood pressure that happens when you change position like standing up

• become dizzy, light headed, collapse 

• common in elderly, anti-hypertensive medicated patients 

•  sit them up slowly after lying down

what is ischaemic heart disease

• how is it caused

• when you dont have enough oxygen for the heart 

• caused by aetiology - plaque in the cornoary arterythat constricts blood flow

what is angina 

• what are its symptoms 

• it is a symptom of ischaemic heart disease 

• crushing sensationin chest

• shortness of breath 

• radiation down left arm neck and jaw 

• nausea and vomiting 

• tachy cardia 

what is treatment of angina 

• beta blockers 

• calcium channel blockers 

• potasium channel activators 

• surgical: coronary artery bypsas graft (CABG)- making a new route for the blood to flow

•  angioplasty ( stent inserted)

how does ischaemic heart disease (IHD)/ angina  affect dental treatment 

• what negatives does it cause orally 

• how do dentist deal with pateints that ahve angina 

• what medical treatments are there

• angina is the symptom u get when ur not getting enough o2 to the heart

• stress could cause angina

• cause jaw/neck pain 

• they could be taking aspirin 

• non urge dental treatment delayed until angina is controlled 

• they take GTN prophylaxis which is a vasodialtor realcing blood vesssel so increasing blood flow to the heart 

• Beta blockers, calcium channel blockers, k channel activators