Cardiovascular disease

Infective endocarditis prophylaxis

Hypertension
Ischemic heart disease
Cardiac arrhythmias
Heart failure

 Infective
endocarditis
prophylaxis

Infective endocarditis
Streptococci and staphylococci:
most common pathogen

Infective endocarditis

Infective endocarditis
prophylaxis

1. Microbial infection of heart or valve

2. Congenital or acquired
.Mitral valve prolapse (30% of cases)

.Aortic valve (12-30%)- -
.Congenital heart disease
.Prosthetic valve -

Mitral valve prolapse

Upper and lower chamber on left side not

close

Criteria for diagnosing IE

major
Positive blood culture
Heart murmur -

MINOR
Fever
Petechiae (conjuctive, palate, buccal
mucosa)

IE: Painful, red nodules

Echocardiogram
confirms vegetation on valve

Current american heart

association recommendations
(2007)
ORAL ANTIBIOTICS: amoxicillin
30-60 minutes before procedure
Adults: 2 g
Children: 50 mg/kg

Current american heart

association recommendations
(2007)
ALLERGIC TO PENICILLIN
Cephalaxin
Adults: 2g
Children: 50mg/kg
Clindamycin
Adults: 600 mg
Children: 20mg/kg

Frequency of bacteremia
ACTION

Tooth extraction
Perio surgery
Scaling/root
planing
Toothbrushing
Toothpicks
Water irrigation
devices
Chewing food

PERCENTAGE
10-100%
36-88%
8-80%
20-68%
20-40%
7-50%
7-51%

Efficacy of AB prophylaxis
Antibiotic prophylaxis: does it reduce the
risk of IE??? Contoversial

Risk IE from dental procedures

Mitral valve prolapse: 1/1.1 million procedures

Congenital heart disease: 1/475,000 procedures
Rheumatic heart disease: 1/142,000 procedures
Prosthetic valve: 1/114,000 procedures

hypertension

ADULT HYPERTENSION
CLASSIFICATION

NORMAL
PREHYPERTENSION
STAGE 1
HYPERTENSION
STAGE 2
HYPERTENSION

SYSTOLIC DIASTOLI
(mm Hg) C
(mm Hg)
<120
<80
120-139
80-89
140-159 90-99
>160

>100

etiology
Primary hypertension: unknown
cause
Secondary hypertension:
1.
renal disease
2.
adrenal disorders

Signs and symptoms

EARLY
Blood pressure readings
high
titinus
Headache
Dizziness

ADVANCED
Hemorrhage retinal
arterioles
Left ventricle
hypertrophy
proteinuria
Congestive heart failure

Angina pectoris

Renal failure

Lifestyle modifications

Weight loss
Reduce cholesterol
Reduce saturated fat
Reduce sodium
Aerobic exercise
Limit alcohol

Dental management
Risk from dental treatment is a
sudden elevation of BP that may lead
to MI or stroke
-/ -
1. STRESS
2. Vasoconstrictors

Dental management
Blood
pressure

Dental tx

Refer to
phycisian

>140/90
<160/100

all

encourage

>160/100
<180/110

All
Monitor BP
throughout

Refer

>180/110

Defer treatment

refer

Dental management in patients with

hypertension
1. Short, morning appts
2. Consider giving Nitrous oxide (sedative)
3. Good local anesthetics (some epinephrine is
allowed)

4. BP monitoring
5. Slow position changes (prevent orthostatic
hypertension)

Ischemic heart disease

ischemic heart disease(IHD)

reduced blood supply of theheart
muscle
usually: atherosclerosisof the
coronary arteries

ischemic heart disease(IHD)

1.
2.
3.
4.
5.
6.

age
smokers
eating meat
hypercholesteremia
Diabetics
hypertension

SYMPTOMS
ANGINA (chest pain on exertion)
Heart failure:
difficult breathing
swelling extremities

DIAGNOSING ischemic heart disease

EKG (electrocardiogram)
BLOOD TESTS: enzymes/electrolytes
Coronary angiogram

TREATMENT ischemic heart

disease
Depending on the symptoms and risk:
1. medication
2. angioplasty
3. Coronary artery bypass surgery
(CABG).

angioplasty

 CARDIAC
ARYTHMIAS

Cardiac arhythmias

Irregular heartbeat
Tachycardia or bradycardia

symptoms
1) Palpitations
2) insufficient blood going into heart
) risks of embolisation:
a) Stroke
b) heart failure
c) sudden cardiac death.

diagnosis
Stethoscope
Feel peripheral pulses
EKG

HEART FAILURE

Congestive HEART FAILURE

Heart cant provide sufficient pump action
Cant distributeblood flowto meet the
needs of the body.

Body fills with fluid

Patients at risk for heart

failure
Ischaemic heart disease62%

Cigarette smoking16%
Hypertension(high blood
pressure)10%
Obesity8%
Diabetes3%
Valvular heart disease2%

Other causes heart failure

It may also occur when the body's
requirements for oxygen and nutrients
are increased and the heart cant
provide
1) severeanemia or vitamin B1
deficiency (beriberi)
2) thyrotoxicosis
3) arteriovenous malformations.

symptoms
shortness of breath
leg swelling

Left side failure: signs

tachypnea (increasedrateof
breathing)
Ralesor crackles, heard initially in the
lung
(may become pulmonary edema
with cyanosis)

right side failure

1) pitting peripheraledema
2) Ascites (excess fluid in abdomen)

Signs
heart
failure

Diagnosing heart failure:

imaging
echocardiography (measures stroke
volume)
(amount of blood in heart that exits ventricles with
each beat)

()

Diagnosing heart failure:

imaging
X-ray: cardiomegaly

Diagnosing heart failure: blood tests

ELECTROLYES
1. Sodium
2. Potassium -

Diagnosing heart failure: blood tests

Poor renal function due to decreased blood
level
poor liver function due to decreased blood
level

Anemia and thyroid function

tests
Anemia and thyroid dysfunction can
cause heart failure

Treatment heart failure

1) Quit smoking
2) light exercise
3) decreased salt intake
4) Medications
5) Pacemakers
6) Heart transplant.

THANK YOU!!!