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Drugs Patients CARDIO – Conditions and Medications • • • • • Ima Bigheart I. P. Freely Chester Payne Seymore Butts Fun K. Rythm Etiology, Treatment and Dental Hygiene Considerations Ima Bigheart Congestive heart failure (CHF) - Overview • Failing heart muscle is enlarged and weak, resulting in reduced cardiac output • Cardiac glycosides are often used to increase heart contractions • • • • • • • • • • Cardiac glycosides ACE inhibitors Diuretics Sodium channel blockers Calcium channel blockers Beta blockers Alpha blockers Nitrates Anticoagulants Anti lipids • If right side fails, blood pools in lower extremities, swelling, thrombi may form, throw emboli. Anticoagulants or antiplatelet aggregation medications are used for prevention http://heart.healthcentersonline.com/bloodclot/embolism5.cfm 1 DH Considerations with C H F • If left side fails, blood pools in lungs, causing dyspnea, orthopnea • Often both sides fail with combination of symptoms RIGHT LEFT Cardiac Glycosides • Drug treatment: cardiac glycosides ie digoxin (Lanoxin), to increase contraction force • Glycosides have narrow therapeutic index, overdose possible (arrhythmias, nausea, l off saliva) lots li ) beware b off epinephrine, OTC cough, cold medicines • Tetracycline, erythromycin can potentiate digoxin by destroying gut flora necessary to deactivate digoxin, cause overdose antiplatelet aggregation drugs • Used to prevent “atherothrombotic events” • Keeps platelets from sticking together • has a higher therapeutic index than Coumadin • Plavix is an example • Consult physician, patient can be safely off • If on anticoagulant or antiplatelet aggregation medication, get medical OK, may have to be off drug • Avoid epinephrine if patient taking cardiac glycosides may trigger arrhythmias glycosides, • May have to sit up patient up while treating because of breathing difficulty • Raise chair back slowly to prevent orthostatic hypotension Anticoagulants • Anticoagulants (Coumadin) used to prevent thrombi and emboli • Heparin used only in hospitals • Coumadin C di increases i prothrombin time from 1.5 to 2.5 times normal • 1.5 times OK, higher is contraindicated • Physician consult necessary before treatment I. P. Freely Hypertension - Overview • For an adult, over 140/90 is high • Over 120/80 is p yp prehypertensive • 90% of HBP patients have essential HBP, exact cause unknown – but diet, stress, heredity big factor • 10% have secondary HBP, other factors cause it (kidneys, CHF) 2 Hypertension • 5% have malignant HBP (diastolic >120) • HBP is often asymptomatic, but can have headache, tinnitus, lightheadedness • Changing lifestyle (diet, exercise, stress, smoking etc.) smoking, etc ) can control it it, if not not, drug therapy recommended. Why is a low salt diet recommended for HBP patients? Drug Treatment for Hypertension Drugs Therapy includes, • Beta blockers • Calcium channel blockers • Diuretics • Alpha blockers • ACE inhibitors Beta Blockers Beta Blockers Parasympathetic nerve (Vagus) Slows heart (rest, digest) Sympathetic nerve speeds p heart ((fight, g flight), g ) up constricts blood vessels to increase BP Sympathetic nerve connects to heart via beta 1 receptor Beta1 blocker drug [Inderal, (propranolol) other –olol’s) slow heart rate(ie decrease cardiac output) by blocking sympathetic beta receptor p beta blocker,, beta 2 If nonspecific in lungs blocked, broncospasm (cough) can occur Other beta blocker side effects are insomnia, depression, fatigue, sexual inactivity Block the beta receptor and blood pressure doesn’t increase Alpha Blockers Sympathetic nerves connect to peripheral blood vessels via an alpha receptor A sympathetic response causes blood vessel to Constrict causing increase in BP Block the alpha receptor and vessel doesn’t respond Alpha Blockers • Alpha blockers include – Minipress (prazosin), C d Cardura (d (doxazosin), i ) Hydrin (terazosin) • Side effects include xerostomia, cough 3 CALCIUM CHANNEL BLOCKERS For SA node and cardiac muscle fibers to work, calcium channels in special cells must open to allow exchange of sodium and calcium. Calcium Channel Blockers Calcium channel blocking drugs Calan (verapamil), Procardia (nifedipine), Cardizem (diltiasem ) slow heart by blocking i calcium i movement Block the calcium channels, and the heart won’t beat as often CCB’s can cause gingival hyperplasia Name two other drugs that Cause hyperplasia. Diuretics ACE Inhibitors • Diuretics inhibit reabsorption of sodium by kidneys causing diuresis (increased urination) • Plasma volume decreases reducing demands on heart, lowering BP • Three kinds, – thiazide (HCTZ, Lozol), – loop (Lasix), – Potassium sparing (Aldactone) • Thiazides used most • Can cause xerostomia ACE Inhibitors ACE INHIBITOR ANGIOTENSION - I • Angiotension II is a naturally occurring polypeptide that raises blood pressure and causes the release of aldosterone (adrenal cortex hormone that controls kidney mineral reabsorption) • Angiotension II is formed when angiotension I combines with the angiotension converting enzyme (ACE) • Inhibit ACE and elevated blood pressure is prevented ANGIOTENSION CONVERTING FACTOR • Common ACE inhibitors include – Zestril (lisinopril), – Vasotec (enalopril), – Lotensin L i (benazopril) (b il) • Side effects include ANGIOTENSION - II = INCREASED BP – Cough – headache 4 Chester Payne Angina Pectoris - Overview • Coronary artery becomes blocked or constricted due to atherosclerosis, heart does not get enough oxygen • Angina pain severe, patient usually ll sits i motionless i l • Treatment – remove or go around block, angioplasty, bypass, stent • Treat with drugs to reduce stress on heart, ie beta blockers, calcium channel blockers Seymore Butts Myocardial Infarction - overview • Myocardial infarction (heart attack) occurs when lack of O2 causes heart muscle to die • Patient squirms to get comfortable, different from angina, pain into left arm, sweat Angioplasty Nitroglycerin • Available in a spray, a patch or a pill • Immediate relief of pain by dilating peripheral blood vessels, relieving demand on the heart • Make sure angina patients have medication handy, they medicate themselves, not you • If multiple doses don’t help, it’s probably a myocardial infarction Myocardial Infarction • Many patients take daily aspirin to prevent platelet aggregation • should not affect bleeding, more will • Patients taking Plavix must discontinue for several days before dental treatment STENT After angioplasty, a metal mesh tube called a stent is sometimes inserted to keep new passage open. 5 Anti lipids • Body needs cholesterol to maintain cell walls • Lipoprotein needed to transport cholesterol • LDL (low density lipoprotein) can build up in blood vessels • (High density lipoprotein) HDL, helps eliminate LDL, therefore “good” Fun K. Rythm Arrhythmia - overview Abnormal action potentials can cause arrhythmias requiring pacemaker, defibrillators,, ablation,, or medication Ablation – a surgical procedure Where the part of the heart sending abnormal action potential is inactivated Defibrillator Patient automatically given a shock if heart WHERE in OMNI? goes into ventricular fibrillation Anti lipids • Antilipids help lower LDL, increase HDL • Drugs include Zocor, Vytorin, Mevacor • NSAIDS can aggravate side effects Ablation • Catheter is guided into heart • Energy source destroys that part of heart sending electrical signals causing arrthythmia Patients with Pacemakers, Defibrillators • Office equipment could interfere but not a big g problem p • Newly placed device may require premed – ask physician • Have a healthy mouth before surgery 6 Sodium Channel Blockers • Used for life threatening arrhythmias • Xylocaine injected directly into heart for critical arrhythmias • Norpace taken daily but causes xerostomia 7