Heart

Disease
JESABEL DE LA GARZA,
SONYA BAUTISTA,
KAMESHA MCFADDEN
LIT FALL 2015

Congestive Heart
Failure

Definition
A syndrome in which an abnormality cardiac function is
responsible for the inability of failure of the heart to
pump blood at a rate necessary to meet the needs of
the body tissues.
Because of the collection of fluids in various body organs
and the inability of the heart to empty each chamber
with sufficient contractile force, the term congestive
heart failure is used

Etiology
Heart valve damage (rheumatic heart disease,
congenital heart disease).
Myocardial failure as a result of an abnormality of heart
muscle or secondary to ischemia.

Risk Factors and Prevention

Acute Hypertensive Crisis which include all of the following:
Head-ache
Mental confusion
Dizziness
Shortness of breath
Chest pain
Massive Pulmonary Embolism which includes all of the following:
Thrombus may form in a lower extremity with low cardiac output and circulatory stasis.
The Thrombus may break loose and carried by the blood, lodge in the pulmonary artery to cause a
pulmonary embolism.
Severe dyspnea, cyanosis, congestive failure and shock result.
Arrhythmia:
After resuscitation of a person with myocardial infarction, ventricular fibrillation, a type of
arrhythmia, is the major risk leading to sudden death.

Signs and Symptoms

Different, depending, in general, on whether the LEFT or the RIGHT side of the
heart or both are affected. The general effects are: Extreme weakness, Fatigue,
Fear and Anxiety.
Left Heart Failure
Right Heart Failure
(receives venous blood from Vena Cava and pumps to
lungs for oxygenation)

(receives oxygenated blood from the lungs)

Subjective symptoms:
Weakness, fatigue

Subjective symptoms:
Weakness, fatigue

Dhyspnea, particularly evident on exertion.

Shortness of breath when lying supine, relief
when sitting up.

Swelling of the feet and/or ankles. Edema

progresses to thighs and abdomen (ascites) in
advanced stages

Cough and expectoration

Cold hands and feet

Nocturia

Objective Symptoms:

Objective Symptoms:
Pallor, sweating, cold skin

Cyanosis of mucous membranes and nail beds

Prominent jugular veins

Breathing with difficulty

Congestion with edema in various organs

Diastolic blood pressure increased

Rapid heart rate

enlarged spleen and liver

GI distress with nausea/vomiting

Fear and anxiety

CNS involvement with headache and irritability

Fear and anxiety

Occurrence in Population
4.8 Million people in the United States have congestive
heart failure.
Prognosis: Poor 50% will only have a 5 year survival

Treatment
Non-Invasive:
Counseling with a brief history of angina pain, the patient is counseled to be reassured that lifestyle
changes are necessary and if followed a productive life can be led.
Lifestyle changes in diet, exercise and no tobacco.
Medications - A variety of medications may be required depending on individual needs.
Surgical Treatment:
Coronary Dilation Percutaneous Transluminal Coronary Angioplasty (PTCA)
Procedure to stretch coronary blood vessel using fluoroscopic guidance
An atherectomy may be used to remove atheromatous plaque from the vessel lining

Coronary Stent
Coronary Bypass Coronary Artery Bypass Grafting (CABG)
Purpose: jump-pass over arteries that have been narrowed with atherosclerosis

Cardiac Pacemaker
When the natural pacemaker cells are not able to maintain a reliable rhythm, or when the impulses are interrupted
because of heart block, cardiac arrest various arrhythmias, or other disease conditions, treatment by a cardiologist
may include the placement of an artificial pacemaker.

Medications
Anticoagulants to prevent embolus and thrombus
formations (Heparin hospital administered intravenous
and Coumarin derivatives).
Diuretics decrease congestion/eliminate water
Digitalis Glycosides increase the force of contractions
Angiotensin reduce blood pressure
Vasodilators reduce resistance to flow of blood.

Dental Concerns
Indications:
Prevent periodontitis studies show a link between
periodontitis and heart disease. If the patient already
has heart disease, there is no need to make it worse.
Contra-Indications Ultrasonic use on a patient with a
pacemaker. Electromagnetic interferences can stopor
alter the function of a pacemaker. Ultrasonic scaling
units, electric toothbrushes, electrosurgery machines,
and certain casting equipment were among the
potential sources of interference with a pacemaker in a
dental care setting.

How will the oral health be impacted?

High Blood Pressure (Hypertension) Oral Effects

dry mouth (xerostomia)

altered sense of taste (dysgeusia).
Syncope, Orthostatic hypotension.
Gingival hyperplasia

Cerebral Vascular Accident/Stroke

Difficulty speaking and swallowing
Increased or decreased sensitivity to pain

Medical Treatment/Medications that impact oral

health
Diuretics which help by decreasing congestion and
eliminating water in patient but may also cause
xerostomia.
Anticoagulants that help decrease the chances of blood
clots may impact the oral health by not clotting open
wounds when dental work is performed.

Periodontal Management
During Chronic Stages:
Physician may prescribe different medications
Dietary Control sodium intake, limited fluid intake, weight
reduction.
Limitation of Activity depending on the severity of the health
problem and the advice of the physician.

EMERGENCY CARE
Position patient upright
Call EMS. Administer Oxygen
Use medical emergency report, Monitor Vitals, Reassure patient

Expectations & Accepted Treatment

Options
Medical Release and Pre-meds needed for patients with
heart disease, pacemakers
Semi-supine to avoid orthostatic hypotension
Topical anesthetic epinephrine helps constrict blood
vessels for less bleeding.
Ultrasonic contraindicated (especially on patients with
pacemakers).

Ischemic Heart
Disease

Definition
Result of an imbalance of the oxygen supply and
demand of the myocardium, which results from a
narrowing or blocking of the lumen of the coronary
arteries.

Etiology
The principal cause of the reduction of blood flow to the
heart muscle is atherosclerosis of the vessel walls, which
narrows the lumen, thus obstructing the flow of blood.

Risk Factors & Prevention

Diabetes
Family history of heart
disease
High blood cholesterol
High blood pressure
High blood triglycerides
Obesity
Physical inactivity
Smoking and other tobacco

Manage diabetes
Exercise
Healthy cholesterol levels
Normal blood pressure
Stop tobacco use
Healthy low fat diet

Signs and symptoms

Angina or chest pain
Shortness of breath
Palpitations
Fast heartbeat
Weakness or dizziness
Nausea
Sweating

Occurrence in population
Main cause of death in the world
In males and females over the age of 40 and 65 years

Treatment
Reduce risk factors
Medications
Surgery (angioplasty, stent placement, and coronary
artery bypass surgery)

Medications
Angiotensin-converting enzyme (ACEIs) inhibitors- relax the
blood vessels and lower blood pressure
Angiotensin receptor blockers (ARBs)- lower blood pressure
by blocking the angiotenisin I receptor
Antiplatelet drugs- prevent formation of blood clots
Beta-blockers- lower the heart rate
Calcium channel blockers- reduce workload on the heart
muscles, lowers blood pressure
Nitrates- dilate blood vessels
Statins- lower cholesterol, by inhibiting HMG-CoA reductase

Dental Concerns
Indications

Contraindications

The link between periodontal

inflammation and cardiovascular
disease clearly point to the need
for maintenance of healthy oral
tissues and prevention of
periodontal infections.

Acute or recent myocardial

infarction within the preceding 3
to 6 months

Dental hygienists need to take

responsibility to inform patients
of the significant relationship
between oral and systemic
health.

Uncontrolled heart failure

Unstable or the recent onset of

angina pectoris

Uncontrolled arrhythmias
Significant, uncontrolled
hypertension

How will oral health be impacted?

Untreated cardiovascular disease are at increased risk
for severe periodontal disease
Chronic periodontitis has been shown involved in
adverse cardiovascular outcomes.
Studies found that the presence of periodontal disease
predicts an increase in morbidity and mortality resulting
from cardiovascular disease

Medical treatment/medications that

impact oral health
Nitrates- Xerostomia, postural hypotension (patient
standing upright too quickly after supine position)
Calcium channel blockers- drug induced gingival
enlargement, postural hypotension
Anti-platelet and anti-coagulants- prolonged bleeding
Angiotensin- converting enzymes inhibitors (ACEIs)burning mouth, loss of taste, dry hacking cough
Beta-blockers- xerostomia
Angiotensin receptor blockers (ARBs)- loss of taste

Periodontal Management
Meticulous review of health history should be reviewed at every
appointment
Emergency treatment should only be conducted in close consultation with
the patient's cardiologist
Scaling and root debridement are low-risk procedures, while maxillofacial
surgery with general anesthesia is a high-risk dental procedure.
Assessment of vital signs is imperative; a blood pressure reading over
180/110 mm Hg is a contraindication for treatment.
Patient should sit upright for several minutes prior to standing to avoid
orthostatic hypotension (a sudden decrease in blood pressure upon
standing).
For post-operative pain relief, acetaminophen should be recommended
instead of aspirin to minimize gingival bleeding

Expectations & Accepted Treatment

Options
Local anesthetic
Benefit from epinephrine in local anesthetic agent

Pre-medication
For very anxious patients: 5-10mg of diazepam the night before and 1-2 hours before
treatment

Patient Positioning
Semi-supine

Appointment Length
Short morning appointments (30-45 minutes)
Must be stress free avoiding psychological or physiological stress that would cause
tachycardia

Ultrasonic Use
Use is ok unless patient has a pacemaker or Implantable cardioverter-defibrillators (ICD)

Recall Intervals
Every 3 months

Myocardial Infarction

Definition

The sudden death of heart muscle due to restricted

flow of oxygenated blood to the heart muscle;
characterized by intense chest pain, sweating,
shortness of breath, or sometimes none of these
symptoms

Etiology
Thrombosis Immediate
Atherosclerosis
Necrosis
Lack of blood to the area

Signs & Symptoms

Pain around the sternum
May last up to hours
Can be sudden, during sleep,
after exercise
Can extend to either arm, neck,
and mandible

Pallor, cold, clammy skin

Anxiety/fear
Weakness, faintness
Difficulty breathing
Nausea, Vomiting

Cold sweat

Possible loss of
consciousness

Cyanosis

Lower BP

Occurrence & Population

British Asians
People aged 50+ years
More common with increasing age
Younger people can be affected too:
3 times more common in young men than in young women
After menopause, female hormones no longer protect the
heart; risk between men and women becomes the same.

More common in those with an existing heart condition.

Treatment
Diet
Exercise
Smoking cessation
Healthy BP, Cholesterol, Glucose
Urgent treatment
Emergency angioplasty
Clot-busting medicine

Medications
If MI is suspected:
Aspirin
Other antiplatelet medicines
Clopidogrel
Ticagrelor
Heparin for a few days to help prevent further blood
clots from forming.
Morphine injection into vein for pain relief

Dental Concerns
Indications

Contraindactions

Prevent
Systemic disease
Bacteremia

Minimum of 6 months after

heart attack

Periodontal disease

CAUTION: Patient is at higher risk for endocarditis

Impact on oral health

Oral health impact from MI

Oral health impact from

treatment/medications
Heparin

Higher risk of periodontal

disease

Prevents blood clots from

forming
Easy bleeding

Excess bleeding during

treatment from
antiplatelet medications

Periodontal Management
DURING AN ATTACK:
Stop treatment
Have the patient sit up to allow for comfortable breathing.
Give patient nitroglycerin
If angina-like pain is not reduced within 3 minutes, prepare for basic life
support.
o Call EMS
o Position with head up for comfortable breathing
o Symptoms are not relieved with nitroglycerin
o Administer 162-325 mg of chewable aspirin
o Monitor vital signs
o Administer oxygen by nonrebreather bag
o Alleviate anxiety; reassure patient.
Call EMT. Administer oxygen.

Expectations & Accepted Treatment

Options
Pre-medication
Prophylactic antibiotic
Pravastatin, aspirin
Patient Positioning
Semi-supine position
Appointment Length
Short morning appointments

Expectations & Accepted Treatment Options

Cont
Ultrasonic Use
Should not be used:
Within 6 months of myocardial infarction
active angina
Recall Intervals
Elective dental appointments
physician gives consent

postponed

until

Questions No. 1
Heart failure is a syndrome in which abnormality of
cardiac function is responsible for the inability or failure of
the heart to pump blood at a rate necessary to meet the
needs of the body tissues. The term congestive heart
failure is used because the heart has the ability to empty
each chamber with insufficient contractile force.
A. First Statement is false, second statement is true
B. First statement is true, second statement is false
C. Both statements are false
D. Both statements are true

Question No. 2
Patients with Cardiovascular disease are at increased risk
for severe periodontal disease. The presence of
periodontal disease can cause an increase in morbidity
and mortality in patients with Cardiovascular disease.
A. Statement A is true, statement B is false
B. Statement B is true, statement A is false
C. Both statements are true
D. Both statements are false

Question No. 3
All of the following are signs or symptoms of a myocardial
infarction EXCEPT:
A. Pain can extend to either arm, neck, and mandible
B. Anxiety/fear
C. Cyanosis
D. Difficulty breathing
E. Higher BP

References

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