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Dental m anagement of patient with cardiac disease and hypertension

Dental m anagement of patient with cardiac disease and hypertension. Risk factors for cardiovascular disease (c v d):. Hypertension. High cholesterol. Obesity. Cigarette smoking. Physical inactivity. Diabetes mellitus. Kidney disease. Family history.

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Dental m anagement of patient with cardiac disease and hypertension

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  1. Dental management of patient with cardiac disease and hypertension

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

  3. Potential problem related to dentalcare • 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.

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

  5. Ischemic heart disease: • A) Angina pectoris. • B) Myocardial infarction. • C) Congestive heart failure. • D) Cardiac arrest (sudden death).

  6. A) Angina pectoris: • 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 .

  7. Treatment: • 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.

  8. B) Myocardial infarction(MI): • 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).

  9. Treatment: • 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.

  10. C) Congestive heart failure: • 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 .

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

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

  13. Treatment: • 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.

  14. Prophylactic antibiotic regimen for cardiac pt: • 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.

  15. 2\Under G.A: • 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. • 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).

  16. PART II

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

  18. Classification:

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

  20. Management in dental office: • 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.

  21. (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.

  22. (sever hypertension>200->110) Defer elective dental treatment unit hypertension is controlled. Consider referral to oral and maxillofacial surgeon for emergent problems.

  23. Thank you

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