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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.