©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 11 Angina Pectoris and Myocardial Infarction

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anatomy of the Heart Four chambered, hollow muscular organ Pericardium: wall that encloses the heart –Three layers: Epicardium (external layer) Myocardium (middle layer) Endocardium (inner layer) 2

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Four Chambers of the Heart 3

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anatomy of the Heart Figure 11-2: Anatomy of the human heart 4

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anatomy of the Heart Four chambers: –Atria: upper chambers Separated into right and left sides by the interatrial septum –Ventricles: lower chambers Separated into right and left sides by the interventricular septum 5

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anatomy of the Heart Right atrium receives blood from all tissues except for the lungs –Blood then pumped to the right ventricle, where pulmonary artery exits and carries blood to the lungs Left atrium receives oxygenated blood from the lungs via pulmonary veins 6

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anatomy of the Heart –Left ventricle connected to the aorta and pumps blood to all the body except the lungs Two types of valves in the heart chambers: –Atrioventricular valves Consist of the tricuspid and mitral valves –Semilunar valves Consist of the pulmonary and aortic valves 7

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anatomy of the Heart Heart muscle must receive an adequate supply of oxygenated blood –Myocardium is supplied with blood by the first branches of the aorta –Left coronary artery supplies blood to the left and right ventricles and left atrium –Right coronary artery supplies blood to the left and right ventricles and the right atrium 8

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Coronary Artery Disease Arteriosclerosis (hardening of the arteries) –Artery walls become thickened and inelastic Atherosclerosis (form of arteriosclerosis) –Affects the coronary arteries and causes coronary artery disease 9

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Coronary Artery Disease –Degree of narrowing determines the adverse effects a patient experiences Angina pectoris Myocardial infarction 10

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Angina Pectoris Latin phrase: “strangling of the chest” Episodes of pain when the heart experiences oxygen deficiency May be the first sign of atherosclerotic disease 11

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms Pain: –Usually in the substernal area of the chest –Can be located anywhere in the chest from the epigastrium to the base of the neck –May spread to the jaw and teeth –Patient may describe as pressure/tightness 12

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms Duration of the pain important: –Usually lasts three to five minutes if precipitating factors are removed –Up to forty minutes if precipitating factors are not removed –If episode continues longer, myocardial infarction should be considered 13

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms Physical signs are not very reliable Patient may: –Appear pale or grey, with cold/clammy skin –Experience a feeling of impending doom Pulse rate and blood pressure may increase slightly 14

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Classifications of Angina Stable: –Pain occurs from physical exertion or emotional upset –Does not alter in frequency, duration, or intensity within a sixty-day period 15

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Classifications of Angina Unstable: –Unpredictable; can occur even at rest –Often increases in frequency, duration, and severity 16

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Precipitating Factors of Angina Episodes Physical exertion Emotional stress Eating or drinking something cold Bathing Dressing Sexual activity Disturbing dreams 17

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Diagnosis If patient experiences chest pain, dentist must try to diagnosis it –Check medical history for cardiac problems –Can ask the following questions: What type of discomfort are you experiencing? Where is the location of your discomfort? 18

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Diagnosis How long did your discomfort last? What preceded the discomfort? What provided relief? 19

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment Remain calm Stop all dental treatment Position the patient Administer nitroglycerin Administer oxygen 20

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment Administer second dose of nitroglycerin, if needed Summon EMS if needed 21

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Nitroglycerin Coronary vasodilator prescribed for the prevention or relief of angina –Helps dilate the coronary arteries to allow more oxygenated blood to reach the heart –Rapid action: within 90 seconds Side effects –Orthostatic hypotension –Severe headaches 22

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Myocardial Infarction Occurs when a portion of the myocardium dies as a result of oxygen starvation caused by the narrowing or complete blockage of the artery Can occur in patients who have not experienced angina pectoris 23

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms Compressing, squeezing pain usually begins in the substernal area and then spreads –Pain may vary from severe to almost none –Pain not relieved by nitroglycerin 24

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms Patient may have: –Cold and clammy skin –Vomiting, nausea, dizziness –Hypotension –Shortness of breath –Sweating –Weakness, extreme fatigue, anxiety –Feeling of impending doom 25

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment Stop dental treatment Administer nitroglycerin Summon medical assistance if nitroglycerin does not relieve pain Keep patient quiet and calm 26

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment Place the patient in whatever position is most comfortable Provide oxygen Be prepared to perform CPR 27

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Differences between Angina and Myocardial Infarction The pain associated with myocardial infarction is: –Greater in severity and duration –Occurs in the absence of physical exertion or emotional stress Angina patient remains motionless 28

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Differences between Angina and Myocardial Infarction The myocardial infarction patient moves about trying to find a comfortable position 29

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Stress Stress plays a major role as a precipitating factor of angina Chest discomfort from a stressful situation tends to last longer than that caused by physical exertion 30

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prevention Better to try to prevent an angina attack from occurring in the dental office than to have to treat an episode –Angina can lead to myocardial infarction Be aware of the patient’s medical history 31

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prevention Make visit as pain free as possible May be necessary to shorten the length of appointments 32

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Summary Heart disease is the leading cause of death in the United States Dental team should do everything possible to alleviate undue stress Be aware of the signs, symptoms, and treatment for a cardiac emergency 33