Emergencies: Heart

  1. Major Cardiovascular Diseases
    • Congenital
    • Rheumatic
    • Infectious Endocarditis
    • Ischemic Heart Disease (IHD)
    •      Angina
    •      Mycardial Infarction
    •      Congestive Heart Failure
    •      Cardiac Arrest
  2. Common Acute Chest Pain in the Dental Setting
    • Angina Pectoris
    • Hyperventilation
    • Myocardial Infarction
  3. Description of Noncardaic Chest Pain
    • Sharp, knife like
    • Stabbing
    • Aggrevated by movement
    • Present only during breathing
    • Localized
  4. Description of Cardaic Chest Pain
    • Dull
    • Aching 
    • Heaviness
    • Present constantly
    • Generalized
  5. What is Angina Pectoris?
    • Severe in and around the heart.
    • Caused by insufficent O2 supply to the myocardium
    • Sign of underlying disease
  6. Predisposing Factors of Angina Pectoris
    • Gender
    • Heredity
    • Race
    • Age 
    • Smoking 
    • Cholesterol Levels
    • Blood Pressure
    • Diabetes
    • Stress
  7. Stable Angina
    • Classic angina
    • Pain is predictively precipitated by stress
    • Symptoms have not changed for at least 2 months; responds to rest and medication
  8. Unstable Angina
    • Pre-Infarction angina
    • Unpredictable in frequency, severity, duration, and response to medication
  9. Variant Angina
    Coronary artery spasms that may be medicated with Calcium Channel Blockers and Nitroglycerin for pain.
  10. Preventative Medications for Angina
    • Long-acting Nitrates- relax smooth muscles
    • Beta-Blockers- block response to catecholamine stimulation
    • Calcium Channel Blockers- relax smooth muscle and dilate coronary arteries
    • Nitroglycerin- single most effective agent that acts as a vasodilator
  11. Nitroglycerin Side Effects
    • Pounding Headache
    • Tachycardia
    • Possible Hypotension
    • Orthostatic Hypotension
    • If orally adminstered, burning at the site of administration
  12. Dental Office Prevention for Angina
    • Medical History
    • Psycho-sedation: N2O2
    • Prophlactic nitroglycerin premed (possibly)
    • Local anesthetics for pain control. Can use up to 0.04mg epinephrine in LA
  13. Treatment of Angina
    • Stop treatment
    • Position patient
    • Adminster nitroglycerin if BP is not lower than normal
    • If chest pain last longer than 10 minutes call 911
  14. What is a Myocardial Infarction?
    • Condition in which part of the myocardium dies. The death of the heart muscle is due to sudden and complete blockage of a coronary artery.
    • Single leading cause of death in the US
    • Most critical in the first 4-6 hours
  15. After Myocardial Infarction
    • Cardiac dysrhythmia can occur and is a high risk for death.
    • Bradycardia
    • Ventricular tachycardia: rapid conractions with inadequate filling
    • Ventricular fibullation: irregular contractions
    • Asustole: absence of heart contraction
  16. Treatment of MI
    • Stop treatment
    • Position patient
    • ABC
    • Definitive Care
  17. Post MI Medications
    • Diuretics: for hypertension and/or heart failure
    • Beta-adrenergic: blocks beta response to catecholamine stimulation and decrease myocardial demand.
    • Ca Channel Blockers: inhibits Ca movement during cardiac and vascular smooth muscle contraction.
    • Nitroglycerin
    • Anticoagulants: decreases emboli
    • Antiplatelets: low dose of asprin
  18. Congenital Heart Disease
    • Congenital heart defects are the most common birth defects
    • 1 out of 125 to 150 babies in the US are born with it
    • Problems range from simple to complex
    • The heart develops at conception to 8 weeks utero
  19. Types of Congenital Heart Defects
    • Problem with too much blood to the lungs
    • Problem with too little blood to the lungs
    • Problem with too little blood traveling to the body
  20. Patent Ductus Arteriosus (PDA)
    • Allows blood to mix between the pulmonary artery and the aorta. Prior to birth there is an opening between the two blood vessels. This should close soon after birth.
    • When the closure doesn’t happen , some blood returns to the lungs
  21. Atrial Septal Defect (ASD)
    There is an opening between the two atria and resulting abnormal blood flow through the heart 
  22. Ventricular Septal defect (VSD)
    There is a hole between the ventricles e.g. blood from the left v flows back into the right v , due to the higher pressure in the left v. this causes an extra volume of blood to be pumped to the lungs a congestion 
  23. Clinical Considerations for CHD
    • Easily fatigued 
    • Exertional dyspnea 
    • Cyanosis of lips, nailbeds 
    • Possible heart murmur 
    • Poor growth & development 
    • Chest deformity 
    • Defective heart valves are susceptible to endocarditis
  24. Rheumatic Heart Disease
    • Complication following rheumatic fever resulting in damaged heart valves 
    • Occurs often between the ages of 5-15 
    • Pharyngeal infection involving the beta-hemolytic group A streptococci. 
    • Immunological disorder of sensitization of antigens to the beta-hemolytic streptococci
  25. Chronic Rheumatic Carditis
    • Scarred valves get secondary bouts of rheumatic fever
    • Leads to Stenosis and regurgitation
    • Scarred valves are easily infected
  26. S & S of Rheumatic
    • Low grade fever 
    • Arthritic joints 
    • Painless swellings 
    • Pink skin rash 
    • Heart valvular damage may occur, usually the mitral valve ; sometimes the aortic valve; heart murmur, cardiac arrhythmias
  27. S & S of Mitral Valve Prolapse (MVP)
    Some symptoms can include palpitations, chest pain, difficulty breathing after exertion, fatigue, cough, and shortness of breath while lying down. 
  28. S & S after RF
    • Shortness of breath 
    • Angina 
    • Elevation of diastolic BP 
    • Enlargement of left ventricle 
    • CHF
  29. Infective Endocarditis
    • Microbial infection of heart valves or endocardium. 
    • Usually occurs where there are congenital or acquired valvar or endocardial defects. 
    • Subacute Infective Endocarditis (SBE) : A transitory bacteremia reaches the heart valves. Masses of bt and blood clots are found on the valves. 
  30. Congestive Heart Failure (CHF)
    • The heart is the body’s pump. 
    • Supplies O2 blood and nutrients to tissues and organs. 
    • In heart failure the heart is unable to pump adequate blood volume. 
    • Fluid begins to back up , pressure in the veins increases and fluid leaks into body tissues; fluid is pushed to the lungs causing them to become wet and heavy.
  31. Causes of CHF
    • CHF is a symptomatic cardiovascular COMPLEX caused by: 
    • Damage to the heart muscle (MI) 
    • Damage to the mechanisms that control inflow and outflow of blood through the heart. (Heart valve disease) 
    • CVD 
    • Hypertension 
    • Diabetes 
    • Chronic Alcohol/ Drug Abuse
  32. CHF Percentages
    • CHF preceded by: 
    • HBP IN 75% cases CAD w/HBP in 39% 
    • Rheumatic heart disease (cardiac valvular disease) in 2% 
    • CHF seen most often in pts > 65 
    • 5 year mortality rate is 50% 
    • For severe CHF the 1 year mortality rate is 50%-60% 
    • Can lead to pulmonary edema
  33. Acute Pulmonary Edema (APE)
    • Sudden , rapid serous fluid accumulation in the lung spaces with extreme difficulty breathing Life threatening 
    • Precipitated by 
    • –Stress 
    • –Salt intake 
    • –infection
  34. S & S APE
    • Slight , dry cough 
    • Wheezing 
    • Dyspnea 
    • Orthopnea 
    • Suffocation feeling 
    • Anxiety 
    • Tachypnea 
  35. Management APE
    • Stop tx 
    • Position pt 
    • 911 
    • Calm 
    • CPR , if needed 
    • O2 
    • Vitals 
    • Bloodless phlebotomy 
    • Vasodilator
  36. Left Ventricular Heart Failure
    • Left ventricular failure is the leading cause of right ventricular failure.
    • LVF : Left ventricle pumps out inadequate volume of O2 blood to the body . 
    • Fluid backs up in lungs
  37. LVF Signs and Symptoms
    • Respiratory distress 
    • Fatigue 
    • Dyspnea, wheezing 
    • Tachypnea 
    • Nocturia 
    • Paroxysmal Noctural Dyspnea or sleep apnea 
    • Pale, sweating
  38. Right Ventricular Heart Failure
    • RVF : The resistance to blood flow through the lungs exceeds the right ventricle’s ability to pump blood into the lungs. 
    • Blood backs up into the liver and other organs 
  39. RVF Signs and Symptoms
    • Generally related to systemic venous congestion & peripheral edema 
    • Pitting edema, clubbed fingers 
    • Weakness , fatigue 
    • Cyanosis 
    • Coolness in extremities 
    • Prominent jugular veins 
    • Exertional dyspnea 
Card Set
Emergencies: Heart
Heart disease, MI, CHF, and CVD