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Cardiovascular. Chapter 15
Terms in this set (106)
What is the cardiac output x the TPR (total peripheral resistance)?
What is the normal blood pressure rate?
What is the systolic and diastolic pressure for Primary Hypertension?
What is secondary hypertension?
Max pressure in arteries exerted when the heart contracts.
Min pressure in the arteries when the heart is at rest.
What are the cardiovascular contraindications to dental treatment?
Acute or Recent Myocardial Infarction (within the last 6 months). Always CONSULT with the pts PHYSICIAN.
What is myocardial infarction?
Heart attack. Heart vessel becomes blocked. Injury or necrosis of the heart muscle can result.
What is the mean arterial pressure (MAP)?
Blood Pressure. = Systolic Pressure
divided by 2.
Increase in HR. + Chronotropic effect.
Decrease in HR. - Chronotropic effect.
Can periodontal disease have an impact on cardiovascular disease?
Yes. Studies have shown that the presence of perio disease can increase morbidity and mortality resulting in cardiovascular disease.
What happens when the left side of the heart fails?
The blood backs up into the pulmonary circulation (lungs).
When the left side of the heart fails, and the blood backs up into the lungs, what is a result of this?
What does pulmonary edema produce?
Dyspnea (difficulty breathing) and Orthopnea (breathing difficulty experienced while lying flat).
How would you position your patient who has left side heart failure?
In a semi-reclined position.
What happens when there is Right-sided heart failure? What are the symptoms?
Systemic congestion. Symptoms include peripheral edema with fluid accumulation evidenced by pitting edema (pedal edema or feet edema).
What can happen overtime with these two Right and Left sided heart failures?
Over time, both sides of the heart can fail.
What is the most commonly used cardiac glycoside for CHF?
What is the major effect of digoxin?
To increase the force and strength of contraction of the heart's myocardium or heart muscle. (+ INOTROPIC EFFECT)
In CHF, does bradycardia occur or tachycardia?
Tachycardia. (Increased sympathetic action = decreased cardiac output)
With digoxin, does bradycardia occur or tachycardia?
Bradycardia. Digoxin increases the cardiac output = sympathetic tone decreased, with a decrease in HR (bradycardia) as the end result.
What does digoxin also reduce?
The EDEMA that occurs with CHF.
What are the uses of Digoxin?
CHF, Artrial arrhythmias, Atrial fibrillation (rapid inefficient contraction of atrial muscle fibers), Paroxymal atrial tachycardia.
What are the adverse reactions of Digoxin?
Narrow therapeutic index- TOXIC EFFECTS COMMON. Gastrointestinal (anorexia, nausea, vomiting and copious salivation). Arrhythmias (cardiac irregularities)...These arrhythmias can progress to ventricular fibrillation and death (Digoxin is used to TX arrhythmias, however, its toxicity can produce arrthymias). Neurologic. Oral. Drug interactions.
What is an Angiotensin?
A cardiac glycoside. Angiotensin-Converting Enzyme Inhibitors (ACEI),
What is considered first line therapy and is considered the cornerstone of CHF therapy? How fast does it improve symptoms?
Angiotensin. Improves symptoms within a period of 4-12 weeks.
What are Vasodilators?
Cardiac Glycosides. Hydralazine and Isosorbide dinitrate.
What is an arterial vasodilator that reduces the peripheral resistance by arterial vasodilation? How does it do this?
Hydralazine (Vasodilator). Reduces the after load (what is in the arteries after the heart), the work of the heart is reduced.
What is a venous dilator?
Isosorbide dinitrate (Vasodilator). Reduces the preload (blood in the veins, going to the heart), which reduces the work of the heart.
With this combination of these two vasodilators what has happend?
The heart is pumping against less resistance and is getting less blood returned to it (some blood remains in the venous circulation). Therefore, the hearts workload is reduces and symptoms of CHF subside.
In heart failure (HF), the heart does not provide .......? ......enlarges? finally becomes......?
adequate cardiac output to provide for the oxygen needs of the body. Ventricle(s) enlarges and finally becomes ineffective as a pump.
What does arrhythmia mean?
Loss of rhythm. Irregular Heartbeat.
What does dysrhythmia mean?
What is Automaticity?
The cells of the cardiac muscles, unlike those of skeletal muscles, have an intrinsic rhythm called automaticity. (Each part has a different rate).
Each type of cardiac cell differs in its automaticity depending on what?
The function of the particular cell.
What had the fastest rate of depolarization and therefore directs all the other cells of the heart?
The sinoatrial (SA) node.
Normally, how many times per min does an electrical impulse generate within the SA node?
80 times per minute.
Where does this impulse continue? What happens?
The electrical impulse continues in the AV node... where it is briefly delayed.
The AV node sends the impulse message via what? to what?
Via the bundle of His to the Purkinje fibers.
What does this conduction result in? What is this system responsible for?
Contraction of the atria followed by Contraction of the ventricles. This system is responsible for coordinating the contractions of the heart chambers and repeats with each heartbeat.
What does electrical excitation from the nerve produce?
It produces movement of ions across the membrane, generating an action potential.
What is an Electrocardiogram?
ECG is a graphic record of the heart's nerve action potential or, in other words, a recording of the electrical activity of the conduction system.
What does the ECG reflect?
Depolarization (sodium ions entering the cell) and repolarization (potassium ions leaving the cell) of cardiac tissue.
How are antiarrhythmic agents grouped?
Placed in groups designated with Roman numerals I to IV. Subsets use capitol letters (A,B,C)
What are the actions of antiarrhythmic agents?
Decrease in the velocity of depolarization, decrease in impulse propagation, Inhibition of aberrant impulse propagation.
What is lidocaine?
An antiarrhythmic. Na+ channel blocker (fast). Blocks conduction, decreases ERP, Shortens the AP.
What are some implications for the management of dental patients taking antiarrythmias?
Check for abnormal or extra beats when taking pts blood pressure and pulse. Record the type of arrhythmia and the drug therapy.
Dental implications of patients on CCB's (antiarrythmia)?
Gingival enlargement (verapamil most reported)
Dental implication of Disopyramide (antiarrythmia)?
Dental implication of Phenytoin (antiarrythmia) ?
Dental implication of B-blockers (antiarrythmia)?
Drug interaction with epinephrine, limit to cardiac dose if pts condition warrants.
What is angina?
Insufficient O2 for the bodies demand.
What is angina pectoris?
Coronary arteries do not supply a sufficient amt of oxygen to the myocardium. Pain or discomfort in the chest radiating to the left arm and shoulder. Lower jaw pain may be confused with a toothache.
What do antianginal drugs do?
Reduce the workload of the heart by decreasing the cardiac output, the peripheral vascular resistance, or both.
What is the most often used nitrate for angina pectoris?
What are significant drug interactions and contraindications for antianginal drugs?
The combination of Phosphodiesterase 5 (PDE5) inhibitors (within the last 24 hrs) used to treat erectile dysfunction, such as sildenafil (viagra), vardenifil (levitra), or tadalafil (cialis) with any type of nitrate can cause dangerously low BP.
If a pt has used a PDE5 inhibitor w/in the last 24 hours, can NTG be given?
NO. It cannot be given.
If symptoms of angina are not relieved by 3 doses of NTG what might the pt be expirencing?
An MI (heart attack). Injury or necrosis of the heart muscle.
What has Nifedipine been associated with (dentally) LOL?
Gingival enlargement and Dysgeusia (impairment and/or perversion of taste)
What is the most common of all cardiovascular diseases?
Why is hypertension called the "silent killer"
What are some complications of hypertension?
Affect organs such as the heart, kidney, brain and retina. MI and CVA.
What is essential hypertension?
85-90% of pts diagnosed with hypertension have Essential, Idiopathic or Primary Hypertension. All stand for hypertension from an UNKNOWN cause.
What is secondary hypertension?
10% of hypertensive pts. IDENTIFIABLE cause. The cause can be identified and associated with (secondary to) a specific disease process involving the endocrine or renal systems. Drugs such as (steriods, NSAIDS, Birth control, decongestants, and tricyclic antidepressants can produce secondary hypertension)
What is malignant hypertension?
BPs are very high or rapidly rising and there is usually evidence of retinal and renal damage. Treated aggressively with antihypertensive agents.
How would you evaluate a patient for hypertension?
Assess lifestyle, ID other cardiovasc. risk factors or disorders that may affect prognosis and tx.
What are some lifestyle modification is pts with hypertension?
Weight reduction, Aerobic physical activity, Diet, Sodium restriction, Moderate alcohol consumption, smoking cessation.
Most people will require how many drugs to control the BP? Are side effects greater or less?
2.. By combining the agents, the side effects of individual agents are less and the high bp can be normalized.
What are some factors affecting bp?
Cardiac Output and Peripheral Resistance.
What is most commonly used for tx of hypertension?
What is the most commonly used thiazide?
What are some adverse rxns to antihypertensive agents?
Hypokalemia-decreased potassium levels. Hyperglycemia. Hyperlipidemia. Hypercalcemia. Hyperuricemia. Anorexia. Xerostomia.
What are a drug interaction with antihypertensive agents?
NSAIDS can reduce the effect of the thiazide diuretics.
What are loop diuretics? What is the most commonly used loop diuretic?
Strong cousins of the thiazides. FUROSEMIDE is the most commonly used loop diuretic. More loss of fluids compared to the thiazides.
What are B-Adrenergic blocking agents?
Used often to treat hypertension.
Nonselective B-Adrenergic blocking agents (Propranolol) block both B1 and B2 receptors. What else can they do?
How do antihypertensive agents lower bp?
By decreasing cardiac output.
What are side effects of antihypertensives?
Bradycardia, mental depression, and decreased sexual ability.
What are some dental drug interactions with antihypertensives?
Nonselective B-blockers can have a drug interaction with EPINEPHRINE, resulting in hypertension.
What are some oral manifestations of antihypertensive agents?
Xerostomia and dysgeusia (altered sense of taste). Gingival enlargement (gingival hyperplasia)
How can antihypertensives effect the respiratory system?
Dry, Hackling cough. Can increase upper respiratory symptoms.
What are some dental drug interactions?
Effectiveness of ACEI's is REDUCED by administration of the NSAID's
What is an adverse rxn to a1- Adrenergic blocking agents an antihypertensive?
Orthostatic hypotension- can result in dizziness or syncope.
How would you alter the dental tx of a person with an adverse rxn to an a1-adrenergic blocking agent used for hypertension?
Raise and Lower the chair slowly.
What do a1 blocking agents antagonize?
The vasoconstriction actions of epinephrine.
What can epinephrine do?
Increase the antihypertensive effect. Severe hypotension and reflex tachycardia can result.
What are some oral effects of the antihypertensive, Clonidine?
Xerostomia (40%), parotid gland swelling, pain and dysguesia.
What is the drug of choice for tx of hypertension during pregnancy?
What are the adverse effects in management of the dental pt taking antihypertensive agents?
Xerostomia. Dysgeusia. Gingival Enlargement. ORTHOSTATIC HYPOTENSION (sudden fall in BP). Constipation. CNS sedation.
What are LDL's?
Low density lipoproteins. BAD CHOLESTEROL bc they carry the greatest concentration of cholesterol and are considered to be the most dangerous.
What are HDLs?
High density lipoproteins. GOOD CHOLESTEROL bc they have the lowest cholesterol content and are considered to be beneficial (they carry cholesterol away from the bvs)
What are the most commonly used antihyperlipidemics?
HMG Co-A reductase inhibitors.
What is an adverse effect of antihyperlipidemic agents?
Contraindicated during pregnancy.
What is the most important/ most used anticoagulant?
Warfarin (Coumadin). It antagonizes vit K, and interferes with the synthesis of 4 clotting factors to produce an anticoagulant effect.
What are adverse rxns to drugs that affect blood coagulation?
Bleeding- most common. Narrow therapeutic index.
What are drug interactions to drugs that affect blood coagulation?
Aspirin. Antibiotics (can potentiate the effect of warfarin). Phenobarbital (can decrease warfarin levels)
How do you monitor a pt taking an anticoagulant?
Using the International Normalized Ratio (INR).
What is the INR?
A function of the prothrombin time (PT) of the pt, PT of control and the international sensitivity index (ISI).
What is prothrombin time?
Time in seconds that it takes for the pts blood to clot when combined with thromboplastin and calcium.
What does INR =?
INR= (PT pt) / (PT contro)
What is a major side effect of Ticlopidine?
Neturopenia ( low WBC count)
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