Dental management of patient with cardiac disease and hypertension by:DR.SUZAN HASSAN Lecture (3).

The main points you must know are: stress reduction protocol. Risk factors for cardiovascular disease. Types of Ischemic heart disease. Treatment plan for this disease. Prophylactic antibiotic regimen for cardiac pt. PART I: CARDIAC DISORDERS :

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. Potential problem related to dental care :

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. Risk factors for cardiovascular disease (c v d):

Chest pain. Dyspnea. Cyanosis. Palpitation. Syncope. Edema of ankle. Clubbing fingers. Cold pale extremities. Easy fatigue. Main signs &symptoms of ( c v d ):

Main disorders including are : A) Angina pectoris. B) Myocardial infarction. C) Congestive heart failure. D) Cardiac arrest (sudden death). Ischemic heart disease :

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. A) Angina pectoris:

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. Treatment:

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). B) Myocardial infarction(MI):

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. Treatment:

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. C) Congestive heart failure:

Consultation with physician. Stress management protocol. Semi supine or up right chair position. Check BP and pulse. Treatment:

May result from an abnormal heart rhythm or be secondary to respiratory arrest, (sudden stoppage of heart). Symptoms: Apnea( stop breathing). Unresponsiveness. Pulse lessness. D) Cardiac Arrest:

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. Treatment:

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. Prophylactic antibiotic regimen for cardiac pt:

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. 2\Under G.A:

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).

PART II

Definition: it is the highest level of BP whether systolic or diastolic (>140mmHg SBP and >90 mmHg DBP) It is a highly common in cardiovascular and renal disease. Hypertension:

categorysystolicdiastolic normal<120<80 Pre hypertension Stage1 hypertension Stage 2 hypertension>160>100 Classification:

Stress. Age. Heredity. Smoking. obesity Major factors associated with hypertension:

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. Management in dental office:

Management of : 1/(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.

2/(sever hypertension>200->110 : Delay the optional dental treatment until hypertension is controlled. Consider referral to oral and maxillofacial surgeon for emergent problems.

Thank you