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Cardiovascular Disease Management in Dentistry

Explore conditions involving the cardiovascular system, risk factors, and treatment implications in dental care. Learn about angina pectoris stress reduction protocols, heart failure, and managing myocardial infarction in the dental office.

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Cardiovascular Disease Management in Dentistry

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  1. Chapter 11: Medical Conditions Involving the Cardiovascular System

  2. Cardiovascular Disease (CVD) • Congenital vs. acquired • Blood vessel-related • Aneurysm • Atherosclerosis /arteriosclerosis • Coronary artery disease • Hypertension • Heart-related • Angina pectoris (chest pain on exertion) • Arrhythmias • Congestive heart failure • Myocardial infarction (heart attack)

  3. Risk Factors for CVD • Smoking • Family history of CVD • Diabetes mellitus • High cholesterol • Obesity • Sedentary lifestyle

  4. Angina Pectoris • Pain in chest from lack of oxygenation of muscle tissue • Associated with: • Atherosclerosis & inability of vessels to dilate • Diversion of blood flow after heavy meal • Symptoms • Types • Application to practice

  5. Angina Pectoris: Stress Reduction Protocol • Keep appointments short • Keep appointment on time to reduce anxiety • Use adequate measures to prevent pain • Consider use of pretreatment antianxiety medication

  6. Management of a Client With Angina • Reposition to upright • Reassure client, maintain composure • Measure & record blood pressure (BP) & pulse • If systolic BP <100 mm Hg: sublingual nitroglycerin (given by dentist) • Provide 100% oxygen • Readminister sublingual nitroglycerin as needed • Call 911 if pain not relieved in 10 minutes • Record events of emergency in dental record

  7. Valvular Heart Disease • Conditions • Damaged heat valves • Congenital heart defects • Heart murmur • Mitral valve prolapse • Rheumatic heart disease • Risk for infective endocarditis • Application to practice • Consult client’s physician prior to oral procedures • For artificial heart valve: • Determine INR values • Use digital pressure to stop bleeding • Use hemostatic rinse

  8. Signs and Management of Cardiovascular Stress • Signs • Perspiration • Nausea • Shortness of breath • Pressure in chest • Management • Perform basic life support • Provide 100% oxygen • Call 911 if not resolved

  9. Heart Failure (HF) • Clinical syndrome characterized by: • Dyspnea • Fatigue • Edema • Results in: • Reduced output of oxygenated blood • Left ventricular failure • Classes • A: Risk for HF • B: Structural heart disease • C: • Structural heart disease • Symptoms of HF • D: • Advanced structural dis. • Marked symptoms of HF

  10. Treatment Implications for Clients With HF • Classes A & B HF • Elective dental care is fine • Class C HF • Medical consult required • Hospital setting may be required for oral care • Class D HF • No elective treatment • Emergency treatment in hospital setting • General • Monitor vital signs • Pulse • Breathing • Observe respiration sounds • Semiupright position • Stress reduction protocol • Supplemental oxygen • Nitrous oxide

  11. Managing Acute Pulmonary Edema in Client with HF • Symptoms • Dry cough • Wheezing • Suffocation & anxiety • Increased respiration rate • Hyperventilation • Management • Call 911 • Place in upright position • Provide basic life support • Provide 100% oxygen • Monitor life signs every 5 minutes & record • Stress reduction protocol • Sublingual nitroglycerin (given by dentist)

  12. Myocardial Infarction (MI; Heart Attack) • Lack of oxygenated blood supply to heart (ischemia) • Caused by: • Atherosclerosis • Vasospasm • Thrombotic blockage • Results in death of heart muscle tissue • Management of client with history of MI • No elective oral treatment within month after MI • Evaluate functional capacity • Determine risk for future MIs • Anticoagulant medication

  13. Managing Acute MI in Dental Office • Symptoms • Squeezing in chest • Pain in chest • Pain radiating to arms, neck, back, or jaw • Difficulty breathing • Perspiration • Nausea • Hypertension • Feeling of impending doom • Management • Place in upright position • If symptoms unrelieved, call 911 • Sublingual nitroglycerin (given by dentist) • Provide 100% oxygen • Monitor vital signs • Have client chew 325-mg aspirin tablet • Provide basic life support

  14. Hypertension/Hypotension • Blood pressure • Force against which heart must pump to perfuse body with blood • Systolic/diastolic • Hypertension • ≥140/90 mm Hg • Increased risk for MI, HR, stroke, renal failure, atherosclerosis • Hypotension • Caused by blood loss or vasodilating medications • Can lead to fainting

  15. Other Conditions • Pacemaker or implanted cardiac device • Cerebrovascular accident (CVA; stroke) • Transient ischemic attack (TIA) • Headache/migraines

  16. Managing Acute CVA in Dental Office • Symptoms • Severe headache • Visual abnormalities • Confusion • Slurred speech • Inability to speak • Numbness • Losing feeling on one side • Management • Place client in comfortable position, head elevated • Ask client to: • Smile • Raise both arms • Speak a simple sentence • Stick out tongue • Call 911 • Provide basic life support

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