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CVD for DH

Cardiovascular Disease

***Congenital Heart diseases*** Caused by genetics (down syndrome,) or environmental factors (Rubella,drugs,diabetes).
Congenital Heart diseases: * Ventricular Septal defect Hole in the wall (septum) dividing the right and left ventricles causing the exchange of blood.
Congenital Heart diseases: * Patent Ductus Arteriosus A shunt between the aorta and pulmonary artery failed to close during birth causing the blood to mix.
Congenital Heart diseases: - Some signs and syptoms Easily tired, dyspnea; fainting, cyanosis of nailbeds and lips, chest deformity, heart murmurs, Congestive heart failure.
Congenital Heart diseases: - Care plan Refer for medical consult before any treatment. Prevent Infective Endocarditis. Eliminate oral diseases.
Congenital Heart diseases: - Follow up Q's -When were you diagnosed? -Do you know the name of the defect? -Did you have any surgeries for it and when? -Do you see your cardiologist regularly? When was the last visit? -Are you taking meds? -Have you ever needed to be premedicated for dental
***Rheumatic Heart Disease*** Life long heart complication caused by Rheumatic fever.
Rheumatic Heart Disease: * Rheumatic fever β hemolytic Group A streptococcal pharyngeal infection.
Rheumatic Heart Disease: - Treatment Early diagnoses of strep throat. Meds- Antibiotics.
Rheumatic Heart Disease: - Care Plan Prevent IE Emphasis on high level of oral hygiene care to prevent oral diseases.
***Infective Endocarditis*** Active infection caused by the colonization of microorganisms usually around the heart valves where there is previous heart damage.
Infective Endocarditis: - Bacteria involved Streptococci and staphylococci. Majority of causes α hemolytic streptococci.
Infective Endocarditis: - Risk Factors Rheumatic heart disease, certain congenital heart diseases, prosthetic heart valve, or previous IE.
Infective Endocarditis: - Premed Plan Premed needed to prevent this for such cases that this is a risk.
Infective Endocarditis: - Care Plan Premed for those susceptible for any gingival instrumentation and OHI. Needs to maintain good oral hygiene.
***Hypertension*** Increased workload on the heart because of persistant elevated blood pressure.
Hypertension: * Pre- hypertension Systolic Diastolic 120-139 80-89
Hypertension: * Hypertension 1 Systolic Diastolic 140-159 90-99
Hypertension: * Hypertension 2 Systolic Diastolic >160 >100
Hypertension: - Care Plan -Cardiac Dose: 2 cartridges of lidocaine w/ 1:100,000 Epi (0.4%) is considered SAFE in ambulatory patients w/ all BUT the most severe CVD -DO NOT use retraction cords containing epi -Nitrous OK (helpful for stress protocol)
Hypertension: - Emergency Situtation The BP cutoff point for giving elective or urgent dental treatment without a med consult is 180/110 •Any dental patient whose BP is > 210/120 should be referred for immediate med consult.
***Ischemic Heart Diseases*** Oxygen deprivation on a local area from a reduced passage of blood.
Ischemic Heart Diseases: - Principal cause Atherosclerosis of vessel walls- narrowing of the lumen with plaque deposits.
Ischemic Heart Diseases: - Manifestations of ischemic heart disease Angina pectoris Myocardial infarction Congestive heart failure Sudden death
Ischemic Heart Diseases: * Angina pectoris * Transient chest pain from lack of oxygen – ischemia Classified as stable and unstable.
Ischemic Heart Diseases: *Angina pectoris - Stable angina - Usually triggered by physical exertion, emotion or a heavy meal. Lasts from 1 to 15 minutes. Relieved by rest OR Administration of sublingual nitroglycerin. ASA III
Ischemic Heart Diseases: *Angina pectoris - Emergency Treatment Reposition to upright position. If systolic BP is > 90-100 administer nitroglycerin. Administer oxygen. Re-administer nitroglycerin (max 3 tabs in 15 minutes) May administer chewable aspirin 160-325 mg. If not responding after 2nd tablet activate EMS
Ischemic Heart Diseases: *Angina pectoris - DO NOT's - Do NOT give nitroglycerin is systolic BP is Below 100.
Ischemic Heart Diseases: *Angina pectoris - Care Plan - Stress reduction protocol. Med consult recommended. Cardiac dose of up to 0.04 mg of vasoconstrictor should be used (no more than two cartridges of 1:100,00 epinephrine or four cartridges of 1:200,000) with stable angina. Postpone tx for unstable angin
Ischemic Heart Diseases: *Angina pectoris - Follow up Q's - What usually causes your angina episode? How often does angina occur? How long does it last? Do you use nitroglycerin to manage the pain? Have you ever needed to call for emergency assistance because of angina? Have you ever had a heart attack?
Ischemic Heart Diseases: * Myocardial Infarction * Occurs when the blood supply to the heart is blocked causing death and/or damage to the heart muscle.
Ischemic Heart Diseases: *Myocardial Infarction - Thrombosis - Primary cause of a MI. Blood clot attached to the intima of a blood vessel, occludes the lumen.
Ischemic Heart Diseases: *Myocardial Infarction - Embolism - Secondary cause of a MI. Sudden blockage of an artery by a blood clot or foreign material, unattached, traveling through the blood stream.
Ischemic Heart Diseases: *Myocardial Infarction - Symptoms •Same symptoms as angina: squeezing sensation or pain in the chest that may radiate to the arms, neck, back, or jaw, Levine sign, difficulty in breathing/dizziness, diaphoresis. Not relieved by nitroglycerin.
Ischemic Heart Diseases: *Myocardial Infarction - Emergency Treatment Position comfortably. Administer 100% oxygen Monitor vitals (BP usually falls during an MI) Administer nitroglycerine tablets One tablet every 5 minutes up to 3 doses (if systolic BP > 90) Administer 162 to 325 mg of chewable aspirin.
Ischemic Heart Diseases: *Myocardial Infarction - If Nitro isn't working - If not responding after 2nd tablet nitroglycerine activate EMS. If no pain relief from nitro, administer 30% Nitrous Oxide If cardiac arrest occurs: CPR or defibrillator while waiting for EMS to arrive.
Ischemic Heart Diseases: *Myocardial Infarction - Care Plan Postpone elective dental treatment for 6 months. Check INR if on blood thinner,(INR should be within therapeutic range of 2.0-3.0). Nitrous OK. Limit epinephrine to cardiac dose IF vasoconstrictor is necessary but should consult with physician.
Ischemic Heart Diseases: *Myocardial Infarction - Follow up Q's When was your heart attack? Any complications? When was your last visit with your physician? Medications: what, how much, and when (regularly and today)?
Ischemic Heart Diseases: * Congestive Heart Failure * Imbalance between the demand placed on the heart and its ability to respond. Involves failure of one or both ventricles. Results in an inadequate supply of blood and oxygen throughout the body and congestion of blood within the vascular system.
Ischemic Heart Diseases: *Congestive Heart Failure - Underlying Causes - Myocardial Infarction Hypertension Congenital heart disease Heart valve damage Cardiomyopathy
Ischemic Heart Diseases: *Congestive Heart Failure - Left Heart Failure - Symptoms Pulmonary edema Dyspnea, SOB (relieved when sitting up) Dry cough (due to congestion in lungs) Weakness, fatigue Diastolic BP increased Rapid heart rate Pallor, sweating, cold skin Fear and anxiety
Ischemic Heart Diseases: *Congestive Heart Failure - Right Heart Failure - Symptoms Usually develops after LHF Swelling (edema) of feet and/or ankles; may progress to thighs and abdomen Dyspnea Prominent jugular vein Cold hands and feet Cyanosis Fear and anxiety Weakness, fatigue
Ischemic Heart Diseases: *Congestive Heart Failure - Emergency Care Position pt. upright Call EMS Administer oxygen Monitor vital signs Reassure patient
Ischemic Heart Diseases: *Congestive Heart Failure - Care Plan Treat patient in a semi-supine position or upright Cardiac dose of epinephrine If taking Digitalis Sensitive gag reflex Avoid epinephrine Med consult based on patient’s cardiovascular history and severity of disease. No treatment unless minimal edem
Ischemic Heart Diseases: *Congestive Heart Failure - Follow up Q's Do you need several pillows to sleep? Do you awaken from sleep short of breath? Can you tolerate being placed in a supine chair position for treatment? Can you walk up a flight of stairs without stopping to rest? How often do you see your physician?
***Arrhythmias*** Any variation in the normal heartbeat includes disturbances of rhythm, rate and conduction patterns of the heart
Arrhythmias: * Tachycardia Abnormally rapid heart rate. >100 beat/minute
Arrhythmias: * Bradycardia Slowness of heartbeat. <60 beat/minute
Arrhythmias: - Common types Atrial fibrillation non- detrimental. Most common cause of sudden death in MI is from ventricular fibrillation.
Arrhythmias: - Care Plan Nitrous oxide ok. Epi may precipitate an arrhythmia or tachycardia. Cardiac dose of epinephrine ok. Epinephrine should be avoided in patients taking Digoxin. Patients on Warfarin (Coumadin) should have INR within range of 2.0-3.0
Arrhythmias: - Follow up Q's When were you diagnosed? What type of arrhythmia do you have? Is your arrhythmia asymptomatic or symptomatic? Are you or have you been treated for your arrhythmia? If so, what treatment did you receive? What medications are you taking?
Arrhythmias: * Cardiac Pacemaker * An electronic stimulator or defibrillator used to send a specified electrical current to the myocardium to control or maintain a regular heart rate
Arrhythmias: *Cardiac Pacemaker - Treatment Modification If unavailable get Med Consult to determine evaluation of the device No antibiotic pre-med needed Usually no restrictions on use of ultrasonic devices
Arrhythmias: *Cardiac Pacemaker - Follow up Q's When was your pacemaker implanted? Does the pacemaker have a shield? When was the function last checked? Has your physician warned you about dental equipment that may interfere with your pacemaker?
***Premed conditions*** Cardiac conditions associated with High Risk for developing IE.
Heart Conditions that Need Premed Prosthetic cardiac valve Previous history of IE
Premeds for Congenital heart defects Unrepaired cyanotic congenital heart disease. Completely repaired congenital heart disease with prosthetic material, 6 months after the procedure. Repaired congenital heart disease with residual defects. Cardiac transplant recipients with valvulopath
***Antibiotics & Dosing*** Amoxicillin 2g *Allergic to penicillins: Cephalexin 2g Clindamycin 600mg Azithromycin or Clarithromycin 500mg
Antibiotic timing Take 30-60 minutes before tx. Can be taken up to 2 hr after procedure if not taken ahead of time. If treating again within 10 days use different antibiotic.
What would you Premed for? For any gingival manipulation. - biopsies - suture removal - placement of ortho bands - root planning - adult prophy - filling or root canal - injections through PDL
What NOT TO Premed for. - Anesthetic injections through non-infected tissue. - X-rays - Placement of removable appliances - Adjusting ortho appliances & placing ortho brackets - Shedding deciduous teeth - Bleeding from trauma to lips or oral mucosa.
Created by: 509032265