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Transcript
Cardiovascular diseases
Dr Hazem Al-Ahmad
B.D.S, MSc(Lon), F.D.S.R.C.S
(Eng)
Cardiovascular disease
• Oral-maxillofacial surgery has minor direct
imapct on vital organ systems.
• Physiologic stresses produced by surgery and
anaesthetic techniques can lead to serious
morbidity and mortality
Ischaemic heart disease
• Insufficent blood supply to the myocardium
due to coronary artery obstruction and spasm
– myocardial ischaemia.
• Angina pectoris – stable/unstable
• Risk factors: family hx, male, increased
cholesterol, hypertension, smoking.
• Nitroglycerin – submucosal for angina only.
• ECG:
ST elevation
Can detect old infarct
• Chest x-ray: can detect congestive heart failure
• Condition needs to be controlled before surgery.
• Postpone surgery after MI for 6 months – risk of
re-infarction.
Myocardial infarction
• Infarcted area become non-functional and
necrotic – dysrhythmias.
• May need a pacemaker
• Some pts receive aspirin or anticoagulants
• Anxiety-reduction protocol
• Prohpylactic GTN
Heart failure
• Right and left ventricular dysfunction
• Diseased myocardium can not meet the
demand – pulmonary edema, hepatic
dysfunction
• Orthopnea, paroxysmal nocturnal dyspnea
• High risk for major cardiac events
• Risk can be reduced with:
Diuretic therapy
Afterload reduction
Digoxin therapy
Anxiety-reduction program
Avoid excessive epinephrine
No supine position
Coronary artery bypass grafting
• Delay major surgery for 6 months after CABG,
• Routine MOS can be safely performed with
anxiety reduction protocols.
Coronary angioplasty
• Same for angina patients
Cardiovascular accidents
•
•
•
•
Patients on anticoagulants
Blood pressure lowering agents
Anxiety reduction protocols
Oxygen suuplements
Dysrhythmias
• Decrease epinephrine
• Anticoagulants or pacemakers (avoid electric
cautery)
Hypertension
• Essential hypertension
• Damage to vital organs: kidneys, brain, heart.
• Many treatment options: diuretics,ACE
inhibitors, angiotensin receptor blockers, Bblockers, calcium channels blockers and
others.
• Delay elective surgery if uncontrolled.
• Low anxiety, low epinephrine.