CVDs
hypertension
MI
drug therapy
life style modifications
diuretics
ACE inhibitors
Betablockers
weight loss + exercise, reduced fat and sodium intake, diabetes control, smoking cessation, alcohol limitation
angina
Arrhythmias
atherosclerosis
heart failure
Diabetes
dental considerations
Statin therapy to lower cholesterol levels
lifestyle modifications
complications
thrombus dissemination leading to acute coronary event
MI
prevents conversion from angiotensin I to angiotensin II
captopril, cilazopril, enalopril
complications: impaired GFR, hypotensive effects
induces sodium and water loss
hydrochlorothiazide, bendrofluzide, mannitol, frusemide
complications: electrolyte imbalance
slow HR and induce vasodilation
propanolol, atenolol, metoprolol, carvedilol, celiprolol
complications: atrial fibrillation, heart failure, fatigue, bradycardia, hypotension
avoid vasopressin as a vasocontrictor (lignocaine with adrenaline ok at a limited dose)
post-operative bleeding
underlying condition: coronary artery disease inflicting MI
drug therapy
nitrates for immediate symptoms
induce relaxation of vascular smooth muscle
life style changes
aspirin (preventive)
anti-coagulation therefore pt will bleed and bruise on surgical innervation, check for asthma symptom exacerbation with NSAIDs
clinical signs and symptoms: chest pain, nausea, sweating and looking ill
managment
Morphine
oxygen
nitrates
aspirin
heparin
complications: arrhythmias, heart failure, hypertension, DVT, death
drug therapy
warfarin therapy (anticoagulant)
aspirin therapy (anti platelet)
aetiology: underlying heart disease/MI
clinical signs and symptoms: palpitations, shortness of breath, chest pain, hypotension
dental considerations: communication with patient, adrenaline (LA) may induce palpitations, anti-coagulant therapy therefore will bleed/bruise more
drug therapy
warfarin therapy
acts on vitamin K dependant factors in coagulation cascade (factor X)
prevents thrombin and fibrin formation therefore prevents clotting
monitored via INR
patients have increased bleeding risk
dental considerations for anticoagulant therapy pt
local measures: pressure, dressings, tansexamic acid, reversal coagulants, topical thrombin
warn about bleeding and bruising, check bloods and bleeding risk, follow up
life style modifications: limit sodium and alcohol
drug therapy: diuretics, ACE inhibitors, nitrates and digoxin
digoxin: increases force of contraction
dental consideration: do not lower below 45 degrees, pt using diuretics may need bathroom breaks
pathological metabolic state from lack of insulin leading to impaired carbohydrate utilisation
life style modification: diet, exercise and blood glucose monitoring
drug therapy: oral hypoglycaemic agents and insulin
dental considerations: short, morning appointments which don't interfere with meal times, antibiotic cover for wound infection prevention, know signs of hypoglycaemia and treat with glucose first
Heart surgery/prosthesis
CABG (coronary artery bypass graft)
Angioplasty/Stent
Valve replacement
dental considerations: pt may be on anticoagulant therapy, consider antibiotic prophylaxis if tx within 6 months stent placement
dental considerations: antibiotic protocol before tx.
no interaction with LA or dental materials
HMG-CoA inhibitor which is responsible for the endogenous production of cholesterol, therefore the drug lowers cholesterol levels
Statin therapy recommended for to with >15% CVD risk
CABG
antibiotic prophylaxis: no erythromycin
Ischaemic heart disease
caused by obstructed coronary. blood flow usually from atheraoscelorosis
signs and symptoms: angina, MI and heart failure
risk factors: smoking, high blood pressure, high cholesterol, diabetes, family history, obesity, stress and sedentary lifestyle
angioplasty/stenting, CABG and carotid endarterectomy