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Dental patients at risk with the use of epinephrine

Dental patients at risk with the use of epinephrine. HTN CVA ASCAD- MI Cardiac arrythmias hyperthyroid sickle-cell anemia cocaine abuse MAOI. Cardiac arrhythmias- general causes. ASCAD other CVD( CHD, MI, CHF, RHD, etc.) pulmonary (COPD) autonomic disorders thyroid disease

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Dental patients at risk with the use of epinephrine

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  1. Dental patients at risk withthe use of epinephrine • HTN • CVA • ASCAD- MI • Cardiac arrythmias • hyperthyroid • sickle-cell anemia • cocaine abuse • MAOI

  2. Cardiac arrhythmias- general causes • ASCAD • other CVD( CHD, MI, CHF, RHD, etc.) • pulmonary (COPD) • autonomic disorders • thyroid disease • medical-systemic diseases • drug side effects • electrolyte imbalances

  3. Cardiac arrhythmias- patient detection • signs: rapid or slow pulse • signs: irregular pulse rhythm • signs: weak pulse • symptoms: palpitations, dizziness, syncope angina, dyspnea, fatigue

  4. Cardiac arrhythmias-symptoms • palpitations • heart failure • fatigue • dyspnea • dizziness • angina • syncope

  5. Cardiac arrhythmias-physical signs • bradycardia( <60 beats per minute) • tachycardia( >100 beats per minute) • irregular pulse rhythm ( regular irregularities, irregular irregularities)

  6. Ectopic beats • premature atrial beats • premature atrio-ventricular beats • premature ventricular beats ( PVCs ) most common

  7. Atrial fibrillation • very common • may or may not be serious • irregular ventricular response • poor atrial transport • emboli

  8. Cardiac arrhythmias-management • ID patients, physical status, risk assessment • other CVD ( i.e. ASCAV, CHF, RHD, MI, CHF, etc.) • other medical-systemic ( thyroid, COPD, MAOI, etc.)

  9. Cardiac arrhythmias-ID patients at risk • HISTORY • MEDICATIONS • STATUS • MONITORING • PHYSICAL EVALUATION = signs and symptoms • MEDICAL CONSULTATION

  10. Cardiac arrhythmias-management • antiarrhythmic medications ( type, dosage, indications, when adjusted, monitored, etc.) • implanted pacemakers • pulse rate, rhythm, character, etc.

  11. Cardiac arrhythmias-medications • Digoxin- slows conduction in the A-V node • Digitoxin- same- more powerful • quinidine- depresses ectopic • procainamide- ventricular arrhythmias • verapamil- regulates Ca++ in slow channels • sotalol/propanolol- beta-blokers • disopyramide- depresses automaticity • lidocaine- emergency Tx

  12. Bleeding problems due to Coumadin • 10-40 % of hospital admissions for bleeding • age-dependent • strength and duration of coumadin Rx • reduction of bleeding with proper anticoagulant monitoring • guideline-based recommendations

  13. Cardiac arrhythmias-management • Close monitoring: vital signs: HR & rhythm • Stress-anxiety reduction • Open-honest communication • Short-non-stressful appointments • Limit/avoid epinephrine • Premedication( daizepam, N2O2)

  14. Cardiac arrhythmias-ID patients at risk • SYMPTOMATIC • Palpitations • Dizziness • Syncope • Angina • dyspnea

  15. Cardiac arrhythmias-ID patients at risk • Patients with signs and symptoms: • NO TREATMENT! • IMMEDIATE REFERRAL FOR MEDICAL MANAGEMENT

  16. Cardiac arrhythmias-CARDIAC ARREST • Ventricular fibrillation progresses to MI • Ventricular asystole no conduction • Agonal rhythm conduction

  17. Cardiac arrhythmias-PACEMAKERS • Generator • Lead • electrode

  18. Cardiac arrhythmias-PACEMAKERS • Type of pacemaker • Type of arrhythmia • Degree of shielding • Date of / complications from implantation

  19. Cardiac arrhythmias-PACEMAKERS • ELECTOMAGNETIC INTERFERENCE • Cellular telephone • Microwave ovens • Electrocautery • Ultrasonic scalers • Electric pulp testers

  20. Cardiac arrhythmias-PACEMAKERS • ELECTOMAGNETIC INTERFERENCE • Cellular telephone • Microwave ovens • Electrocautery • Ultrasonic scalers • Electric pulp testers x

  21. Cardiac arrhythmias-PACEMAKERS • Symptomatic sinus bradycardia • Symptomatic A-V block( 1,2,3) • Tachycardias refractory to Rx therapy

  22. Cardiac arrhythmias-medications side effects • Lichenoid reactions • Lupus erythematosus lesions • Digitalis • Quinidine • Procainamide

  23. CARDIACARRHYTHMIAS Dr. Nelson L. Rhodus Distinguished Professor Director of Oral Medicine University of Minnesota

  24. Bradycardias • sinus bradycardia( normal EKG pattern) <60 BPM • sinoatrial heart block • atrioventicular heart block ( AV-1,2,3 degrees)

  25. Tachycardias • sinus tachycardia ( >100 per minute) • atrial tachycardia ( >150-200 per minute) • atrial flutter ( >220-360 per minute) • atrial fibrillation ( >400-650 per minute) • ventricular tachycardia ( 3 or more at >100 per minute)

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