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