CC OS - CARDIO

• Heart


  • A muscular organ responsible for pumping blood to different parts of the body through blood vessels
  • Approximately the size of a fist
  • Located just behind and slightly to the left of the sternum (breast bone)
• Nerve supply of the heart


  • Vagus nerves – slows down the heart by initiating the emission of acetylcholine
  • Accelerance nerve – speeds up the heart by emitting noradrenaline
• Blood supply of the heart

  • Two major coronary arteries that branch off from the aorta near the point where the aorta and left ventricle meet
• Anatomy of the heart

  • Superior vena cava
  • Inferior vena cava
  • Right atrium
  • Left atrium
  • Right ventricle
  • Left ventricle
  • Pulmonary artery
  • Pulmonary vein
  • Sinoatrial node
  • Heart valves (4)
• Normal cardiac and pulse rate values

  • <1 year old: 100-160 bpm
  • 1 to 10 years old: 70 – 100 bpm
  • >10 years old: 60-100 bpm
  • Trained athletes: 40-60bpm
• Pulse deficit


  Heart rate>pulse rate
• Tachycardia


  Rapid heart rate
• Causes of tachycardia


  • Physiologic
  • Electrical conduction (Atrial tachycardia)
  • Psychological (Fear, Anger, Excitement)
  • Fever
  • Dehydration
  • Hormonal problems (Hyperthyroidism)
  • Heart defects (Tetralogy of Fallot, Septal defects)
• Bradycardia


  Slow heart rate
• Causes of bradycardia


  • Excellent physical condition
  • Electrical conduction (Third degree heart block, Vaso-vagal stimulation)
  • Increased intracranial pressure
  • Hormonal problems (Hypothyroidism)
  • Medications (Atenolol, Diltiazepam)
• Cardiovascular conditions


  • Congenital heart disease
  • Rheumatic heart disease
  • Atherosclerosis and arteriosclerosis
  • Hypertension
  • Congestive heart disease
  • Angina pectoris
  • Myocardial infarction
• Congenital heart defect (CHD)


  • Defect in the structure of the heart and great vessels of a newborn
  • Can obstruct blood flow or cause blood to flow through the heart in an abnormal pattern
  • Can also affect heart rhythm
• Types of obstruction defects

  • Pulmonary stenosis
  • Aortic valve stenosis
  • Coarctation of aorta
• Obstruction defects


  Can cause heart enlargement (cardiomegaly) or hypertension
• Types of septal defects

  • Ventricular septal defect
  • Atrial septal defect
• Septal defects


  May or may not cause cyanosis depending on the severity of the defect
• Types of cyanotic defects

  • Persistent truncus arteriosus
  • Total anomalous pulmonary venous connection
  • Tetralogy of Fallot
  • Transposition of great vessels
  • Tricuspid atresia
• Rheumatic heart disease


  • Condition in which the heart valves are damaged by rheumatic fever
  • Rheumatic fever begins with a strep throat
• Symptoms of rheumatic fever

  • Sudden onset of sore throat
  • Pain on swallowing
  • Fever, usually 101–104°F
  • Headache
  • Red throat/tonsils
  • Abdominal pain, nausea and vomiting
• Symptoms of heart disease

  • Chest discomfort or pain
  • Irregular or rapid heartbeat
  • Shortness of breath
  • Fatigue or weakness
  • Light headedness, dizziness or fainting
  • Swelling of stomach, feet or ankles
• Antibiotic premedication


  • Previously required for a vast number of heart conditions to prevent infective endocarditis
  • American Heart Association updated guidelines in 2007 to classify heart disease into high, moderate, and negligible risk
• No convincing evidence linking dental procedures with the development of endocarditis

  
• Blood pressure


  Amount of force exerted on the arteries when the heart beats (systolic pressure) and when the heart is at rest (diastolic pressure)

  
• Hypertension


  • High blood pressure (systolic pressure 130 mmHg or higher or diastolic pressure 80 mmHg or higher)
  • Often symptomless, but directly increases the risk of coronary heart disease and stroke
• Blood pressure classification 2013

  • Normal
  • Elevated
  • Stage 1 Hypertension
  • Stage 2 Hypertension

  
• Blood pressure classification 2017

  • Normal
  • Elevated
  • Hypertension Stage 1
  • Hypertension Stage 2
  • Hypertensive Crisis

  
• ASA classifications related to hypertension

  • Stage I Hypertension – ASA II
  • Stage II Hypertension – ASA III
  • Hypertensive urgency – ASA IV
• Unsafe blood pressure level for dental procedures

  Uncontrolled BP, defined as 180/110 mm Hg or greater, is classified as a minor risk condition with respect to surgical procedures and outcomes

  
• General management of hypertensive patients

  • Premedication (maintenance medications, pain medication, drug history)
  • Consider sedation (prevent rise in blood pressure, decrease blood pressure)
  • Medical referral and co-management (cardiologist, internist, anesthesiologist)

  
• Pain associated with dental procedures, whether real or imagined, is a major source of stress for the patient

  
• Stage I Hypertension


  ASA II
• Stage II Hypertension


  ASA III
• Hypertensive urgency


  ASA IV
• At what level of BP is treatment unsafe for the patient?
• The 2017 ACC/AHA guidelines still state that uncontrolled BP, defined as 180/110 mm Hg or greater, is classified as a minor risk condition with respect to surgical procedures and outcomes; thus, most dentistry is considered safe up to these levels

  
• Although there are no clinical studies, it is generally recommended that non-emergent procedures be avoided in patients with a blood pressure of greater than 180/110 mm Hg

  
• General Management


  1. Stress Management

  2. Premedication

  3. Consider sedation

  4. Medical referral and co-management
• Pain Associated With Dental Procedure Whether Real Or Imagined Major Source Of Stress For The Patient

  
• Adequate Pain Control Techniques Is Of Paramount Importance!
• Local Anesthesia


  Best managed under local anesthesia