Major Cardiovascular Diseases
- Infectious Endocarditis
- Ischemic Heart Disease (IHD)
- Mycardial Infarction
- Congestive Heart Failure
- Cardiac Arrest
Common Acute Chest Pain in the Dental Setting
- Angina Pectoris
- Myocardial Infarction
Description of Noncardaic Chest Pain
- Sharp, knife like
- Aggrevated by movement
- Present only during breathing
Description of Cardaic Chest Pain
- Present constantly
What is Angina Pectoris?
- Severe in and around the heart.
- Caused by insufficent O2 supply to the myocardium
- Sign of underlying disease
Predisposing Factors of Angina Pectoris
- Cholesterol Levels
- Blood Pressure
- Classic angina
- Pain is predictively precipitated by stress
- Symptoms have not changed for at least 2 months; responds to rest and medication
- Pre-Infarction angina
- Unpredictable in frequency, severity, duration, and response to medication
Coronary artery spasms that may be medicated with Calcium Channel Blockers and Nitroglycerin for pain.
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
Nitroglycerin Side Effects
- Pounding Headache
- Possible Hypotension
- Orthostatic Hypotension
- If orally adminstered, burning at the site of administration
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
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
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
After Myocardial Infarction
- Cardiac dysrhythmia can occur and is a high risk for death.
- Ventricular tachycardia: rapid conractions with inadequate filling
- Ventricular fibullation: irregular contractions
- Asustole: absence of heart contraction
Treatment of MI
- Stop treatment
- Position patient
- Definitive Care
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.
- Anticoagulants: decreases emboli
- Antiplatelets: low dose of asprin
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
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
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
Atrial Septal Defect (ASD)
There is an opening between the two atria and resulting abnormal blood flow through the heart
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
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
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
Chronic Rheumatic Carditis
- Scarred valves get secondary bouts of rheumatic fever
- Leads to Stenosis and regurgitation
- Scarred valves are easily infected
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
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.
S & S after RF
- Shortness of breath
- Elevation of diastolic BP
- Enlargement of left ventricle
- 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.
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.
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)
- Chronic Alcohol/ Drug Abuse
- 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
Acute Pulmonary Edema (APE)
- Sudden , rapid serous fluid accumulation in the lung spaces with extreme difficulty breathing Life threatening
- Precipitated by
- –Salt intake
S & S APE
- Slight , dry cough
- Suffocation feeling
- Stop tx
- Position pt
- CPR , if needed
- Bloodless phlebotomy
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
LVF Signs and Symptoms
- Respiratory distress
- Dyspnea, wheezing
- Paroxysmal Noctural Dyspnea or sleep apnea
- Pale, sweating
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
RVF Signs and Symptoms
- Generally related to systemic venous congestion & peripheral edema
- Pitting edema, clubbed fingers
- Weakness , fatigue
- Coolness in extremities
- Prominent jugular veins
- Exertional dyspnea