Ischemic heart disease & Dentistry
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Ischemic heart disease is caused by a constriction of the coronary arteries reducing blood supply and oxygen to the heart. Key predisposing factors include smoking, hypertension, high fat diet, stress, and genetic predisposition. There are different types of ischemic heart disease including chronic forms with no acute symptoms, angina which causes temporary chest pain, and myocardial infarction where there is irreversible damage due to complete artery occlusion. Management involves stopping any dental treatment, activating emergency services, giving medications like nitroglycerin and aspirin, and oxygen supplementation. Dental procedures require consideration of medications the patient is taking and reducing stress and trauma.
Ischemic heart disease & Dentistry
- 1. Ischemic Heart Diseases BY : CEZAR E. LAHHAM
- 2. Outline : ▪ Definition ▪ predisposing factors ▪ Types ▪ Management ▪ Dental considerations
- 3. Definition ▪ Ischemia = Oxygen supply ▪ Ischemic heart disease= constriction in the coronary artery = Blood supply to the heart = Oxygen
- 4. Predisposing factors ▪ Smoking ▪ Exercise ??!! ▪ Genetic ~30% ▪ Hypertension ▪ Too much fat exposure ▪ Stress ▪ Rare~ mal-formed coronary artery ~Tumors adjacent to artery
- 5. Types ▪ Chronic ▪ Acute Angina Pectoris Stable Unstable MI Prinzmetal
- 6. Chronic IHD NO ACUTE PHASE!!
- 7. Acute IHD
- 8. -Chest pain(retrosternal pain) -Extends to the left hand -Shoulder -Neck -Lower jaw Other features : (more related to MI) -Sweating -Nausea& Vomiting -Pallor CLINICAL FEATURES OF ACUTE IHD
- 9. Angina ~reversible Stable ▪ With predisposing factors ▪ Lasts <5 mins Unstable ▪ Without predisposing factors @Rest ▪ Lasts >10 mins
- 10. Add a Slide Title - 3
- 11. Management :- -Stop treatment -Remove any object from pt’s mouth -Stress reduction protocol -Activate EMS if this is a 1st attack for a pt or it happens to be a worsen attack for a pt with a past history of angina attacks -UPRIGHT position -Give NG 0.3 mg SL then check BP ! After that if the pain is continued Give another NG (You can until 3 tabs “Btw them 1.5 min”) - Give 4-6 L/min Oxygen - -If pt doesn’t respond to treatment ER
- 13. Myocardial Infartion -Complete occlusion in coronary artery -Irrevesible necrosis in heart tissues =Irreversible damage -1st MI <2nd MI < 3rd MI < < < severity -Lasts > 15 mins -Crushing type chest pain
- 14. Management -Stop treatment & remove objects for pt’s mouth -Activate EMS -Lay the pt down to access ABC & monitor vital signs -Give MONA 2-5 mg Morphine & Oxygen “4-6 l/min” & Nitroglycerin 0.3 SL & 162-325 mg Aspirine -Monitor the breathing & Pulse CPR in case of cardiac arrest
- 17. Common drugs ▪ After “Chief complaint” Medical history ▪ Dental History ▪ Examination ▪ Drug-Drug interaction (e.g cipro&warfarin ) ▪ STRESS Aspirin Cholesterol-reducing M (-statins) ACE inh B Blockers ARB Nitroglycerin Others
- 18. PREVENTION Check BP Check cholesterol level :HDL& LDL Medications Consultation from physician to stop any anticoagulant drug Reduce the stress & trauma during any procedure . .