Ppt Materi Om 2 Cardiovascular Disease

8/18/2019 Ppt Materi Om 2 Cardiovascular Disease

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CARDIOVASCULA


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Cardiovascular syste


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Hypertension

Coronary Heart Disease

Acute Coronary Syndromes

Valvular Heart Disease

Heart Failures

Arrhythmia

Endocarditis


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1 HYERTENSIONDEFINITION• Hypertension is defined as having systolic blood pressure (SBP) >140 m

diastolic blood pressure (DBP) > 90 mmHg• As having to use antihypertensive medications

CLASSIFICATION(According to etiology)

• Primary (Essential)

• Secondary

(According to SBP and DBP score)

• Normal

• Prehypertension

• Stage 1 hypertension

• Stage 2 hypertension


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RISK FACTORS

• HTN is well recognized risk factors for CAD• With improved control of BP, there has been a

steady decrease in mortality from CHD aneven greater decrease in mortality from stroke

• Treatment focuses on prevention to reducecomplications -> brain, heart, kidney, eyes,

peripheral arteries• Complications -> Cerebral hemorrage, left

ventricular hypertrophy, CHF, renalinsufficiency, etc


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DIAGNOSIS

• Hypertention usually has a long and asymtomatic course -> undiagnosed• Diagnosis is made only after an elevated BP has been recorded on multiple

Stage 1 : SBP 140 to 150 mmHg or DBP 90 to 99 mmHgStage 2 : SBP >160 mmHg or DBP > 100mmHg

• The BP level determines severity of HTN• 3 main goals of medical evaluation :

- Identify tretable of curable cause- Assess the impact of persistently elevated BP on target organs- Estimate the patient overall risk profile for the development of the CVD- Routine history and physical examintaion should be performed


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EXAMINATION:

• Routine HistoryDuration of the hypertention and any prior treatment

• Physical Examination -> Sign of end-organ damage and a cause of hypertention and a cause of secondary hypertention, Peripheral puauscultated, funduscopic assessment

• Laboratory Routine blood chemistries, fasting lipid (total, HDL, chotriglycerides), twelve-lead electrocardiography (ECG).

• Additional Testing Electrocardiograhy, Ambulatory BP Monitoring, activity testing, radiologic testing


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MANAGEMENT

Lifestyle modification

Medication• Diuretics : Reduce blood volume oral dryness, lichenoid reactio

• b-blockers : reduce stimulation by sympathetic nervous system dryness, oral ulceration, taste changes

• Calcium channel blockers : reduce calcium flow into heart musctherefore heart rate relax smooth muscle lining coronary arteries gingival overgrowth

• Angiotensin-converting enzyme

• Inhibitors (ACEIs) : interfere with renin-angiotensin pathway

• angiotensin II receptor blockers lichenoid reaction

• Direct vasodilators : open up blood vessels (reduce resistance)lupuslike oral and skin lesion, lymphadenophaty

• Centrally acting agents.


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ORAL HEALTH CONSIDERATIONS

• Effect of HTN on Oral Health1. More sensitive to adrenaline in dental anesthetics2. Medications lead to dry mouth3. Increased bleeding after dental surgery

• Dentist should be aware of medications that1. May have systemic side effects that are of importance to provision of care

2. Interact with medications used during dental care3. Cause intraoral changes -> oral dryness, gingival overgrowth, ulceratotions

• Concentrations of epinephrine greater than 1:100.000 aren unnecessary and crisk


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2 CORONARY ARTERY DISEASE (CADDEFINITION• Condition when coronary arteries become narrowed by a gradual b

fatty material within their walls. The condition is called Atherosclerosifatty material is called atheroma

• 30-50% of all CVD

Disrupt of vascularnedothelium

Plaque formation

Chronic reductiocoronary blood floensuing myocar

ischemia/ acute prupture


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• Atherosclerosis may affect any vascular bed -> coronary, cerebral. Rmesenteric, and peripheral vascular system

• When end-organ blood flow is compromised, the resulting ischemia subsequent organ dysfunction

ETIOLOGY- Artherosclerosis- Fatty streak -> progress into plaque -> thrombotic occlusions and co

events- Lipid metabolism abnormalities, systemic hypertension, diabetes me

cigarette smoking -> total atherosclerosis plaque burden


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RISK FACTORS- Risk factors assessment is useful as a guide to therapy for dyslipidemia

hypertension, and diabetes

Hypertension DMCigaretteSmoking

LifestyleDiatery f

Exercise Obesity LipidsVitamin

Homocy

PlasmaFibrinogen

AntioxidantsEndothelialDysfunction


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RISK FACTORS MODIFICATION- When artherosclerosis is identified -> relieve symptoms and improve o

perfusion

- Risk factor modification -> prevent ongoing atherosclerosis- Smoking cessation, meticulous control of hypertension and DM, weig

management, agressive lipid-lowering therapy -> should be all advise- Lipid-lowering therapy with HMG CoA reductase inhibitor -> reduce m- Low-fat, low-calorie diet -> also effective

DIAGNOSIS

- Clinical presentation -> taking history or resting symptoms including chtightness, jaw discomfort, left arm pain, dyspnea, or epigastric distress

- Test : Blood test, doppler ultrasound, ankle-brachial index, electrocard(ECG). Stress test


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MANAGEMENT- High blood pressure -> Angiotensin-converting enzyme (ACE) inhibitors, calci

blockers, thiazide diuretics- High colesterol level -> Statins- Preventing blood clots -> Antiplatelets- Surgery -> Coronary artery bypass graft (CABG), Carotid arteries, Carotid

endarterectomy, carotid angioplasty Extracranial to intracranial bypass

DENTAL CONSIDERATION- Prevent ischemia and infarction

- Impaired hemostatis due to one or more medications may also require dentamodifications

- Side effects from cardiac drugs -> cause oral change- Current cardiac status and medications should be discussed with the patient


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3 Acute coronary syndrome

• Sudden rupture of an atherosclerotic plaque with ensuing intracoronathrombus formation that acutely reduces coronary blood flow -> ACUCORONARY SYNDROMES (ACSs)

• Acute coronary syndrome (ACS) refers to a spectrum of clinical presen

ranging from those for ST-segment elevation myocardial infarction (ST

presentations found in non –ST-segment elevation myocardial infarctio

(NSTEMI) or in unstable angina

• Atherosclerosis is the primary cause of ACS


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SIGN AND SYMPTOMS

Atherosclerosis is the primary cause of ACS

• Palpitations

• Pain, which is usually described as pressure, squeezing, or a burning

across the precordium and may radiate to the neck, shoulder, jaw, ba

abdomen, or either arm

•

Exertional dyspnea that resolves with pain or rest• Diaphoresis from sympathetic discharge

• Nausea from vagal stimulation

• Decreased exercise tolerance


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DIAGNOSIS

Patient’s history, electrocardiography (ECG) is the most important diagn

MANAGEMENT• Initial therapy -> stabilizing patients condition, relieving ichemic pain,

antothrombotic therapy

• Pharmacologic anti-ischemic -> Nitrates, beta blockers• Pharmacologic antithrombotic -> Aspirin, clopidogrel, prasugrel, tica

glycoprotein

• Pharmacologic anticoagulant -> UFH, LMWH, Factor Xa inhibitors


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SYMPTOMSMitral valve disease symptoms vary depending on the exact problem witA problem with your mitral valve may cause no symptoms at all. When syoccur, the can include:

• Cough

• Shortness of breath (especially when you are lying down on your back• Fatigue and tiredness

• Lightheadedness

DIAGNOSIS• Imaging test -> endocardiogram, x-ray, cardiac catheterization, etc

• Test of monitor heart activity -> electrocardiogram• Stress test

MANAGEMENT• Drugs and medications

• Valvuloplasty

• Surgery


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B. AORTIC VALVE DISEASE

DEFINITION

Aortic valve disease is a condition in which the valve between the ma

chamber of your heart (left ventricle) and the main artery to your bodywork properly.

ETIOLOGY:

Congenital, rheumatic and senile calcific valve disease

Aortic Regurgitation (AR) imposes an acute or chronic volume load subsequent eccentric hypertrophy, LV enlargement, and eventual LV

DIAGNOSIS:• Hystory heart murmur, exertional or resting dyspnea, or symptoms

such as orthopnea, paroxysmal nocturnal dyspnea, or peripheral ed

• Auscultatory findings harsh systolic crescendo-decrescendo murmdiminished or absent aortic component of the second heart sound.

TREATMENT:

Surgery


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C. PROSTHETIC HEART VALVES

DEFINITION

Bioprosthetic valves used in heart valve replacement generally offer functional prhemodynamics, resistance to thrombosis) that are more similar to those of nImplantation of prosthetic cardiac valves to treat hemodynamically significant aovalve disease has become increasingly common.

CLASSIFICATION:

Mechanical caged-ball (Starr-Edwards) valve, the single tilting-Shiley) valve, and bileaflet tilting-disk valves.

Bioprosthetic Heterografts, Homografts.

THERAPY:

Anticoagulant (tipically with warfarin) to prevent thromboembolism


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ORAL HEALTH CONSIDERATION


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5 Heart failures

• Inability of the cardiovascularsystem to meet the demandsof the end-programs

• May be due to pericardialdisease, valvular heart

disease, most commonly ->myocardial disease ->Systolic and Diastolicdysfunction


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SIGN AND SYMPTOMS

• Exertional dyspnea and/or dyspnea at rest• Orthopnea• Acute pulmonary edema• Chest pain/pressure and palpitations• Tachycardia• Fatigue and weakness• Nocturia and oliguria• Anorexia, weight loss, nausea, etc

DIAGNOSIS

The following tests may be useful in the initial evaluation for suspected heart failure• Electrocardiography• Complete blood count (CBC)• Urinalysis• Electrolyte levels• Renal and liver function studies• Fasting blood glucose levels• Lipid profile


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MANAGEMENT

• Nonpharmacologic therapy: Oxygen and noninvasive positventilation, dietary sodium and fluid restriction, physical activ

appropriate, and attention to weight gain• Pharmacotherapy: Diuretics, vasodilators, inotropic agents,

anticoagulants, beta blockers, and digoxin• Surgical options

ORAL HEALTH CONSIDERATIONS

• No special dental modifications for this patient• But, when patient suffer from uncompensated CHF, it is prudent to inquire abou

to be placed in a suspine positions


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6 arrythmia• Is abnormalities of the heartbeat or cardiac rythms

• Caused by Primary cardiovascular disease, Pulmonary disorders, Autodisorders, Systemic diseases, Drug-related adverse effects, Electrolyteimbalances.

• Symptoms :

Fatigue Dizziness Lightheadedness

Fainting or near-fainting spells Rapid heartbeat or pounding

Shortness of breath Chest pain In extreme cases, collapse and sudden cardiac arrest


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TREATMENT

• Bracycardias -> Pacemaker • Tachycardias -> Vagal maneuvers, Medications, Cardioversions, Cat

Ablations• Implantable devices : Pacemaker, ICD

• Surgery

ORAL HEALTH CONSIDERATIONS• Patients with supraventicular tachycardia -> Should be only treated b

consultation by cardiologist

• Patients with defibrilations and pacemaker -> no oral prophylaxys unpatients presents with an acute odontogenic infections


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6


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6 ENDOCARDITIS

Infection of the endocardial surface ofthe heart (see the image below), whichmay include one or more heart valves,the mural endocardium, or a septaldefect. Its intracardiac effects includesevere valvular insufficiency, which may

lead to intractable congestive heartfailure and myocardial abscesses. If leftuntreated, IE is generally fatal.


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ETIOLOGY

Approximately 70% of infections in Endocarditis are caused

by Streptococcus species, including S viridans, Streptococcus b

enterococci. Staphylococcusspecies cause 25% of cases and ge

demonstrate a more aggressive acute course (see the images

PREDISPOSING CONDITION: Mitral valve prolapse

Aortic valve disease Congenital heart disease Prosthetic valve Intravenous drug use No identifiable cause in 25-47%


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MANAGEMENT

- Antibiotic -> Penicillin G, Gentamicin

DENTAL CONSIDERATION:

Antibiotic prophylaxis a very high risk of developing endocarditis:

• Prosthetic heart valves.

• Previous infectious endocarditis.

• Congenital heart disease, only in the following

• Heart transplant patients who develop cardiac valve disease.


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Ppt Materi Om 2 Cardiovascular Disease

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