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Chapter 48
Cardiovascular Disease
| Term | Definition |
|---|---|
| Strategies for stress reduction? | good communication, reduce anxiety, scheduling, suggestions for patient, length of treatment and pain control. |
| Good communication? | empathetic and effective in order to establish trust and therefore determine reason for patient's anxiety. |
| How to reduce anxiety? | if advised an antianxiety premedication is of help. This is taken one at night and one an hour before the appointment. |
| Scheduling to reduce stress? | yes, it helps to schedule early in the day so the patient is not worrying about an appointment all day. |
| What type of suggestions can be given to the patient? | Simple such as advising to eat a normal meal before an appointment and to leave for appointment with ample time. Being hungry and rushing to an appointment will increase anxiety. |
| Length of appointment? | Shorter appointments are ideal for stress reduction. |
| Pain control? | This can be a combination of pain medication and local anesthesia. It is also important to manage the patient's pain before, during and after the appointment. |
| HBP Medication Abbreviations | ACEI: angiotensin-converting enzyme inhibitor AIIB: angiotensin II blockers BB: beta blockers CCB: calcium channel blocker HCTZ: hydrochlorothiazide ( Thiazide ending name DIURETIC TYPE) |
| Cholesterol Meds Abbreviations | STATIN: limit lipid synthesis |
| GLYCOSIDE TYPE MED | CONGESTIVE HEART FAILURE (CHF) ATRIAL FIBRILLATION |
| Lanoxin/Digoxin | LOTS OF SALIVA STRONG or Sensitive Gag reflex Remember??? Lano/Digo/ Glyco sort of rhyme??? |
| BETA BLOCKERS (BB) TYPE MEDS (All end in LAUGH OUT LOUD) Atenolol, propanolol, metoprolol, bisoprolol | HBP ANGINA LESS SALIVA DUE TO TOO MUCH LAUGHING OUT LOUD |
| Atenolol Propanolol Metoprolol Bisoprolol | LESS SALIVA DUE TO TOO MUCH LAUGHING OUT LOUD |
| DIURETIC TYPE MEDS (Endings: thiazide, ide, tone) | HBP and CHF Diuretics = LESS SALIVA |
| Diuril/Clorothiazide | Diuril (Think: Diu=Diuretic!!) Diuretics = LESS SALIVA |
| Lasix/Furosemide | Furosemide (Think: ide ending is like the clorothiazide ending= Diuretic too!!) Diuretics = LESS SALIVA |
| Aldactone/Spironolactone | Spironolactone (Think: Watch your TONE is bad for your heart and makes things spiral around out of control) Diuretics = LESS SALIVA |
| CALCIUM CHANNEL BLOCKERS (CCB) TYPE MEDS (Endings: mil,pine, dil, zem) Think: The pine tree is blocking the channel of milk (calcium) dilzema like dilemma ??? | HBP ANGINA |
| Cardizem/Diltiazem Procardia/Nifedipine Norvasc/Lotrel/Amlodipine Calan/Verapamil Vascor/Bepridil | LESS SALIVA = GINGIVAL ENLARGEMENT TOO |
| ANGIOTENSIN-CONVERTING ENZYME INHIBITORS MEDS (ACE) ( Endings : PRIL) Think States : I convert and inhibit my tension at the beach in Puerto Rico or the snow in Illinois. | HBP |
| Vasotec/Enalapril Zestril/Lisinopril (I am famous as I am the most commonly mentioned medication) Lotensin/ Benazepril | LESS SALIVA (Think Thirsty at the Beach in Puerto Rico) ORAL ULCERATIONS/TASTE IMPAIRED (Think the snow in Illinois boohoo its freezing cold) |
| VASODILATOR TYPE MED (Ending: glycerin) Think: glycerin softens/relaxes things | ANGINA |
| Nitroglycerin | I go under the tongue so it BURNS THE TONGUE |
| ANGIOTENSIN II RECEPTOR INHIBITORS TYPE MEDS (Ending in dis, pro, sartan, zaar, van) Think: This pro tarzan sahara the van ???? | HBP |
| Avapro/Irbesartan Losartan/Cozaar Diovan//Valsartan Micardis/Telmisartan | LESS SALIVA ORAL ULCERATIONS/TASTE IMPAIRED (Think: It is so hot in the Sahara that I am thirsty and my mouth is sore from how dry it is????) |
| ANTICOAGULANTS TYPE MEDS (Endings: rin, xaban, din) | ANGINA STENT PLACEMENT AFTER MYOCARDIAL INFARCTION (MI) |
| Lovenox/Enoxaparin Coumadin/Warfarin (think: the commas had a war with the colons) Calciparine/Heparin (think: Calci, he parked in the right area.) Xarelto/Rivaroxaban | MORE BLEEDING THAN USUAL patient education centered around homecare to reduce biofilm for a reduction in inflammation |
| ANTIPLATELET AGENTS | ANGINA AFTER MYOCARDIAL INFARCTION (MI) |
| Aspirin/Acetylsalicylic acid Triclopidine/Triclid Clopidrogrel/Plavix | LESS BLOOD CLOTTING = WATCH OUT FOR MORE BLEEDING |
| Risk Factors for Cardiovascular Disease (CVD) HOW MANY????? | 3 RISK FACTORS |
| 1. Nonmodifiable: Personal Factors | Genetics, age, race, gender |
| 2. Disease Patterns (history of eating disorders and fen-phen) | History of eating disorders anorexia nervosa or bulimia History of fen-phen use (fenfluramine/phentermine) |
| 3. Modifiable Risk Factors | Type A personality, professional stresses, use of oral contraceptives, tobacco, sedentary occupation/lifestyle, diet high in calories (cholesterol/fat/sodium), hypertension, obesity, lipid abnormalities, diabetes, periodontal disease |
| Examples of Nonmodifiable Personal Factors | family history of cardiovascular disease etc. pathologic changes in arteries >40 years of age Blacks/Hispanics more likely to suffer CVD Up to age 40, Men 4x likely to have coronary heart disease as woman |
| Examples of Disease Patterns | Women >40 yrs of age > risk for coronary heart disease if current or past history of eating disorder Fen-Phen = damaged heart valves if > 2 months use |
| Examples of Modifiable Risk Factors | Personality traits (A type) overwork/excess worry Highly stressful professions/great responsibilities Heart Disease risk women use oral contraceptives if <40 Smoking/Smokeless Tobacco, lack of exercise, etc Review Table 48.1 |
| Protocol for Patient with no history of HBP, but presents with elevated blood pressure (protection from health risk unmet need) (could be that the patient has dental anxiety/must monitor at every appt and use stress reduction strategies) | Repeat BP measurement about 5-10 min apart from initial reading and use opposite arm. HIGH DIASTOLIC > 90= NO TREATMENT Limit to assessments/non invasive and planning/ refer to physician for consult and diagnosis. |
| Protocol for Patient under treatment for HBP | Verify patient took Rx meds Implement stress reduction protocol (nitrous oxide, etc) Monitor, remeasure periodically and record readings during appt. |
| Protocol for Noncompliant patient with HBP Tx (protection from health risk unmet need) | Uncontrolled HBP/No compliance with taking Rx meds Stop care after assessments/patient education about importance of protection from health risk and controlling HBP, relationship with oral cavity etc. Refer to physician for consultation and tx |
| Protocol for patient with HBP and Acute Symptoms (protection from health risk unmet need) | DIASTOLIC >110= NO TX and IMMEDIATE MEDICAL CONSULT REFERRED TO PHYSICIAN Stress reduction protocol if patient has dental anxiety for future appt |
| ANGINA | Lack of oxygenated blood to heart= chest pains that radiates to the left arm, neck, shoulder Reduce stress (shorter morning appointments) Medical tx=goal to reduce O2 demand/increase O2 supply |
| Rheumatic Fever | Complication by not treating strep pt may be taking prednisone or other corticosteroid= susceptible or more prone to infection |
| Rheumatic Heart Disease Results from rheumatic fever=thickened/constricted valve (s) | Often requires surgery to repair or replace valve (s) Need medical consult, ANTIBIOTIC PREMED, stress reduction protocol, careful tissue manipulation, pre-procedural rinse, monitor vitals |
| Infective Endocarditis (infection of the endocardium/inner lining of heart) | History of this = high risk for recurrence Medical Consult/ANTIBIOTIC PREMED Careful manipulation of soft tissue, pre-procedural rinse |
| Valvular Heart Defect If defects left untreated= Congestive Heart Failure (CHF) | Valvular repair/replacement with prosthetic valve Medical Consult/Infective endocarditis is possible= ANTIBIOTIC PREMED...... if SRP planned and taking anticoagulant/check with specialist medication dosage |
| Mitral Valve Prolapse (improper closing of leaflets of this valve causes blood to go back into the left atrium) | Medical consult/Possible ANTIBIOTIC PREMED Careful manipulation of tissue, pre-procedural rinse |
| Cardiac Dysrhythmias and Arrhythmias are dysfunctions of heart rythm/rate. Forms of Dysrhythmias: (Bradycardia <60 BPM Tachycardia >150 BPM and Atrial Fibrillation) | Unshielded Pacemaker (electrical interferences disturbs and cause malfunction) USE OF ELECTRICAL DENTAL EQUIPMENT/ULTRASONIC DEVICES IS A NO NO IF UNSHIELDED PACEMAKER PLACE A LEAD APRON TO PROTECT PATIENT PACEMAKER FROM OTHER SOURCES OF INTEREFERENCE |
| Hypertension If taking diuretics= possible xerostomia If taking calcium blockers= possible gingival enlargement | Stress reduction protocol, no tx if uncontrolled BP, no epinephrine POTENTIAL EMERGENCY: CARDIOVASCULAR ACCIDENT (CVA) MYOCARDIAL INFARCT (MI)/HEART ATTACK |
| Coronary Heart Disease / Coronary Artery Disease (CAD) or Ischemic Heart Disease Insufficient blood flow from coronary arteries to heart/myocardium | Caused by high cholesterol, HBP, unhealthy life style EMERGENCIES: MYOCARDIAL INFARCT (HEART ATTACK) OR ANGINA Have nitroglycerin available from patient in case needed, stress reduction protocol |
| Congestive Heart Failure (CHF) (ineffective heart pumping which leads to fluid build up in lungs, legs, etc. Signs include shortness of breath and/or swelling of ankles/legs) Medical Consult to find out the underlying cause for premed. | The underlying cause of this could be hypertension, valvular heart disease, MI, coronary heart disease) SEMI TO UPRIGHT DENTAL CHAIR POSITION FOR COMFORT Stress reduction protocol and if on diuretics= xerostomia |
| Congenital Heart Disease (surgery to correct defect) | Medical Consult to eval need for antibiotic premed Stress reduction protocol |
| What is an implantable cardioverter defibrillator? | this is a device that delivers electrical shock in order to prevent potentially dangerous abnormal heart rhythm. MEDICAL CONSULT NEEDED ULTRASONIC INSTRUMENTATION MAY BE CONTRAINDICATED/ ASK IN THE MEDICAL CONSULT IF CAN USE!!!! |
| What is metabolic syndrome? | group of abnormal findings related to the body's metabolism (excess body fat, high triglycerides, HBP , high cholesterol.) Increased risk of diabetes, heart disease or stroke. MONITOR BP at every appt. |
| Periodontal Disease may contribute to the risk of developing cardiovascular disease (CVD)? | YES |
| Should the practitioner follow the "Prevention of Infective Endocarditis" guidelines from the American Heart Association? | YES Also, strive to maintain the oral health of patients with cardiovascular disease (CVD) |
| How can hypertension be detected at a dental hygiene appointment? | By measuring BP reading as part of the dental hygiene assessment. |
| Unstable angina pectoris indicates that a patient has increased chest pain at rest and during sleep. Patients with unstable angina are at risk for possible medical emergency and should not be treated in the dental setting until medically cleared. | BOTH STATEMENTS ARE TRUE. |
| Too much nitroglycerin can cause headache. | TRUE |
| The drug of choice for patients with angina is nitroglycerin. This drug is usually administered sublingually. | BOTH STATEMENTS ARE TRUE |
| Dental hygiene care should be postponed if a patient has had a myocardial infarct within 30 days of the scheduled appointment or if ischemic symptoms persist. | TRUE |
| When can cardiac rhythm malfunction be detected while in the dental hygiene appointment? | Cardiac dysrhythmias and arrhythmias may be detected when assessing the patient's pulse rate. |
| The following are examples of dental equipment that can cause interference and malfunction of unshielded pacemakers: | ultrasonic scalers pulp testers air abrasion systems computerized periodontal probes low or high hand pieces |
| Why do patients with congestive heart failure need to be seated in an upright position? | Because they may have difficulty breathing, therefore, a supine or even semi-supine is not advised. |
| Remember that: | patients with history of CVD can be given local anesthetic agents that contain EPINEPHRINE at a MINIMALLY SAFE DOSE |
| Anticoagulant meds and dental tx | Need medical consult and prothrombin time values within normal range before rendering treatment because of the increased bleeding time. |
| Don't forget that: | Patients taking immunosuppressant medication for a heart transplant and calcium channel blockers for HBP are at risk for medication induced gingival inflammation/enlargement |
| How can CVD be prevented? | healthy life style (reduction in saturated fats, cholesterol, sodium intake, stress, no tobacco use and increase in exercise) |
| Some Types of Antibiotic Premedication's are: | Amoxicillin Z-Pack/Zythromax Cephalexin/Keflex Clindamycin |
| What is cardiovascular disease (CVD)? | an alteration of the heart and/or the blood vessels that impairs the function and it is the leading cause of death worldwide. |
| Disorders associated with Coronary Heart Disease | Angina Pectoris Myocardial Infarction Arteriosclerotic Heart Disease Coronary Insufficiency |
| Myocardial Infarction is also know as | Heart Attack Coronary Occlusion Coronary Thrombosis |
Created by:
IBrandt
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