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There are two types of congenital heart disease: cyanotic and acyanotic. What is cyanotic heart disease?
Disorder that cause insufficient amount of O2 in blood causing bluish-grey skin.
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What is the most common complication of Infective Endocarditis?
Heart failure which results from sever valvular dysfunction.
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Pathologic feature of finger related to infective endocarditis?
Clubbing finger
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What is AHA recommendation for IE about antibiotic prophylaxis?
- Use antibiotic prophylaxis only in pt with high risk of adverse outcomes from endocarditis who undergo dental procedure that involve:
- gingival tissue,
- periapical region,
- perforation of mucosa.
Remember: anesthetic injection doesn't need antibiotic prophylaxis.
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Which endocarditis pateints need antibiotic prophylaxis (pt with high risk of adverse outcomes from endocarditis)?
- Patients with:
- 1. prosthetic cardiac valve
- 2. cardiac transplant
- 3. Previous Infective Endocarditis
- 4. Congenital Heart Disease :
- 4.1 unrepaired cyanotic CHD
- 4.2 just gotten surgery for CHD - within 6 months
- 4.3 CHD with residual defect
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Oral and IV antibiotic prophylaxis :
- Amoxicillin 2 g oral
- Ampicilin 2 g IM or IV
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Alternativ for pt allergic to penicillins :
- Cephlexin 2 g oral
- Cefazolin/ Ceftriazone 1 g IM or IV
- Clindamycin 600 mg oral
- Clindamycin Phosphate 600 mg IM or IV
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How long does patient need to take the antibiotic before the visit?
30-60 minutes
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Characteristic of stable angina pectoris :
- chest pain is predictable and reproducible
- precipitated by physical efforts
- relieved by rest and nitroglycerine
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Characteristic of unstable angina pectoris :
- new onset, changing, more frequent, more intense
- occur at rest/ precipitated by less effort
- nitroglycerine doesn't relieve pain readily
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How can you tell when it is angina pectoris or acute myocardial infarction?
- Angina pectoris is a brief pain, usually last 5-15 minutes.
- Pt with myocardial infarction will have chest pain longer than 30 min, shortness of breath, arrhythmia, and doesn't respond to nitroglycerine.
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Medication used to treat the pt with stable angina pectoris:
- Nitroglycerine (vasodilator) for acute pain + prophylaxis
- Beta-blocker (↓BP then ↓O2 deman)
- Calcium channel blocker (vasodilator + ↓♡) for stable
- Antiplatelet (aspirin, clopidogrel)
- Remember: for pt taking nonselective beta blocker:
- limit epinephrine to 0.04mg (2 cart)
- avoid impregnated retraction cord
Remember2: If pt taking aspirin (or any platelet aggregation inhibitor), discontinuation of med. is not recomm.
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Surgery for pt with stable angina pectoris:
- Revascularization:
- - stenting
- - coronary artery bypass grafting
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Medication used to treat acute myocardial infarction :
- MONA:
- - Morphine
- - O2
- - Nitroglycerine
- - Aspirin 160-135 mg
- Remember: when stable AMI pt will get surgery treatments (stent, graft)
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Dental management for pt with stable angina pectoris or Hx of MI later than 6 months
- Short morning appointment
- Semisupine (no supine : ↑ venous return)
- Nitroglycerin readily available
- Limit vasoconstrictor to 0.04 mg
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Antibiotic prophylaxis for pt with stent or graft:
- Doesn't need! Antibiotic prophylaxos is not recommended fot pt with hx of:
- coronary artery bypass graft (CABG)
- angioplasty
- stent
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If pt with MI have pacemaker of implanted defibrillator, avoid use of:
- electrosurgery
- ultrasonic scalers
Remember: antibiotic prophylaxis is not recommended
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Dental management for unstable angina pectoris or Hx of MI less than 6 months
- Consult physician
- Avoid elective care
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Pts with ischemic heart disease and congestive heart failure may take antiplatelet drugs. Dental surgery can be done when their PT and INR...
- PT ≤ 2 times
- INR ≤ 3.0 (some say 3.5)
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