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Chapter 11: Medical
Conditions Involving the
Cardiovascular System
Cardiovascular Disease (CVD)
• Congenital vs. acquired
• Blood vessel-related
• Heart-related
–
Angina pectoris (chest pain
on exertion)
–
Arrhythmias
–
Aneurysm
–
Atherosclerosis
/arteriosclerosis
–
Congestive heart failure
–
Coronary artery disease
–
Myocardial infarction (heart
attack)
–
Hypertension
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Risk Factors for CVD
• Smoking
• Family history of CVD
• Diabetes mellitus
• High cholesterol
• Obesity
• Sedentary lifestyle
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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
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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
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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
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Valvular Heart Disease
• Conditions
• Application to practice
–
Damaged heat valves
–
Congenital heart defects
–
Heart murmur
–
Mitral valve prolapse
–
Rheumatic heart disease
• Risk for infective
endocarditis
–
Consult client’s physician
prior to oral procedures
–
For artificial heart valve:
• Determine INR values
• Use digital pressure to
stop bleeding
• Use hemostatic rinse
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Signs and Management of Cardiovascular
Stress
• Signs
• Management
–
Perspiration
–
Perform basic life support
–
Nausea
–
Provide 100% oxygen
–
Shortness of breath
–
Call 911 if not resolved
–
Pressure in chest
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Heart Failure (HF)
• Clinical syndrome
characterized by:
–
Dyspnea
–
Fatigue
–
Edema
• Classes
–
A: Risk for HF
–
B: Structural heart disease
–
C:
• Structural heart disease
• Results in:
• Symptoms of HF
–
Reduced output of
oxygenated blood
–
Left ventricular failure
–
D:
• Advanced structural dis.
• Marked symptoms of HF
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Treatment Implications for Clients With
HF
• Classes A & B HF
–
Elective dental care is fine
• General
–
Monitor vital signs
• Pulse
• Class C HF
–
Medical consult required
–
Hospital setting may be
required for oral care
• Class D HF
• Breathing
–
Observe respiration sounds
–
Semiupright position
–
Stress reduction protocol
–
No elective treatment
–
Supplemental oxygen
–
Emergency treatment in
hospital setting
–
Nitrous oxide
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Managing Acute Pulmonary Edema in
Client with HF
• Symptoms
• Management
–
Dry cough
–
Call 911
–
Wheezing
–
Place in upright position
–
Suffocation & anxiety
–
Provide basic life support
–
Increased respiration rate
–
Provide 100% oxygen
–
Hyperventilation
–
Monitor life signs every 5
minutes & record
–
Stress reduction protocol
–
Sublingual nitroglycerin
(given by dentist)
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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
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Managing Acute MI in Dental Office
• Symptoms
• Management
–
Squeezing in chest
–
Place in upright position
–
Pain in chest
–
–
Pain radiating to arms,
neck, back, or jaw
If symptoms unrelieved,
call 911
–
–
Difficulty breathing
Sublingual nitroglycerin
(given by dentist)
–
Perspiration
–
Provide 100% oxygen
–
Nausea
–
Monitor vital signs
–
Hypertension
–
Have client chew 325-mg
aspirin tablet
–
Feeling of impending doom
–
Provide basic life support
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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
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Other Conditions
• Pacemaker or implanted cardiac device
• Cerebrovascular accident (CVA; stroke)
• Transient ischemic attack (TIA)
• Headache/migraines
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Managing Acute CVA in Dental Office
• Symptoms
• Management
–
Severe headache
–
Visual abnormalities
–
Confusion
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Slurred speech
–
Inability to speak
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Numbness
–
Losing feeling on one side
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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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