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Chapter 11: Medical Conditions Involving the Cardiovascular System

Chapter 11: Medical Conditions Involving the Cardiovascular System. Cardiovascular Disease (CVD). Congenital vs. acquired Blood vessel-related Aneurysm Atherosclerosis /arteriosclerosis Coronary artery disease Hypertension. Heart-related Angina pectoris (chest pain on exertion)

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Chapter 11: Medical Conditions Involving the Cardiovascular System

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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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