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Dental m anagement of patient with cardiac disease and hypertension. Risk factors for cardiovascular disease (c v d):. Hypertension. High cholesterol. Obesity. Cigarette smoking. Physical inactivity. Diabetes mellitus. Kidney disease. Family history.
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Dental management of patient with cardiac disease and hypertension
Risk factors for cardiovascular disease (c v d): • Hypertension. • High cholesterol. • Obesity. • Cigarette smoking. • Physical inactivity. • Diabetes mellitus. • Kidney disease. • Family history. • Older age(>55 yrs for male->65 yrs for female). • Periodontal disease.
Potential problem related to dentalcare • Stress and anxiety related to dental visit must be reduction by (stress reduction protocol): • Premedication . • Short and morning appointment. • Avoid excessive amounts of epinephrine. • Nitrous oxide-oxygen.
Main signs &symptoms of ( c v d ): • Chest pain. • Dyspnea. • Cyanosis. • Palpitation. • Syncope. • Edema of ankle. • Clubbing fingers. • Cold pale extremities. • Easy fatigue.
Ischemic heart disease: • A) Angina pectoris. • B) Myocardial infarction. • C) Congestive heart failure. • D) Cardiac arrest (sudden death).
A) Angina pectoris: • It is a myocardial ischemia resulting from imbalance between coronary blood flow &oxygen demand. • Signs & symptoms: • Central , substernal chest discomfort. • May radiate into shoulders ,arms ,neck ,jaw or epigastric region. • Dull ,heavy ,pressure sensation of short duration<5min • Prompt relief with rest and\or nitroglycerin sublingual tablets .
Treatment: • Position patient semi-upright or upright. • Administer oxygen • Administer nitroglycerin 0.4mg sublingual every five minutes. • Assess and record vital signs . • Call ambulance number if pain not relieved with 2 doses of nitroglycerin over a (10 min) period.
B) Myocardial infarction(MI): • It results from occlusion of coronary artery by thrombus so deficient coronary arterial blood supply to a region of myocardium that results in a cellular death and necrosis. • Signs & symptoms: • Central , substernal chest discomfort. • May radiate into shoulders ,arms ,neck , jaw or epigastric region. • Dull , heavy pressure sensation . • Dyspnea , syncope , diaphoresis , sudden death. • Pain not relieved by nitroglycerine or rest( long duration).
Treatment: • Call ambulance immediately. • Position pt semi-upright or upright. • Administer oxygen. • Administer nitroglycerin 0.4mg every five minutes. • Initiate fibrinolysis ,if possible (aspirin). • Calm and reassure pt. • Assess and record vital signs.
C) Congestive heart failure: • It is the ability of heart to pump sufficient blood to meet the metabolic needs of the heart. • Symptoms: • Fatigue , dyspnea ,ankle edema and orthopenea .
Treatment: • Consultation with physician. • Stress management protocol. • Semi supine or up right chair position. • Check BP and pulse.
D) Cardiac Arrest: • May result from an abnormal heart rhythm or be secondary to respiratory arrest. (sudden stoppage of heart). • Symptoms: • Apnea( stop breathing). • Unresponsiveness. • Pulse lessness.
Treatment: • Call ambulance. • Lay pt supine with board beneath chest or move to the floor. • Attach AED . • Begin basic life support (CPR). • Ventilate with 100% oxygen if possible. • Assess and record vital signs.
Prophylactic antibiotic regimen for cardiac pt: • 1\under L.A: • Adult: 2mg amoxicillin (1 hour before dental procedures). • Children: 50 mg per kg amoxicillin. • If pt is allergic: • Adult: clindamycin 600 mg (1 hour before Tx). • Child: clindamycin 20 mg per kg.
2\Under G.A: • Adult: 1mg amoxicillin I.V at induction. • Or 3 mg amoxicillin orally 1 hour before induction followed by 3mg amoxicillin immediately after recovery. • Children: 5-10 yrs:0.5 adult dose. • < 5 yrs : 0.25 adult dose. • Antibiotic prophylaxis is recommended for cardiac pt to prevent infective endocarditis (infection of the endocardial surface of the heart may include one or more heart valves).
Hypertension: • Definition: it is the highest level of BP whether systolic or diastolic (>140mmHg SBP and >90 mmHg DBP) • It is a highly prevalent cardiovascular, renal disease.
Major factors associated with hypertension: • Stress. • Age. • Heredity. • Smoking. • obesity
Management in dental office: • 1\assess the family history of cardiovascular disease and other related disease. • History of hypertension ,duration ,medication , anti hypertensive treatment history and its complication. • Before starting dental treatment should be assess the presence of BP.
(mild & moderate hypertensive >140->90): Monitor the patient Bp when given local anesthesia with epinephrine>0.04mg in signal visit. Use anxiety reduction protocol. Avoid rapid posture changes in patient taking vasodilatation drug. Avoid administration of sodium containing intravenous solution.
(sever hypertension>200->110) Defer elective dental treatment unit hypertension is controlled. Consider referral to oral and maxillofacial surgeon for emergent problems.