Heart Disorders Anna Rusnak

Scott Sonnier
Iesha Washington

Cardiovascular disease is the name given to a variety of diseases that affect the heart and blood vessels.
Ischemic heart disease-
-called coronary heart disease
-caused by a decrease in blood flow through one or more of the blood vessel that carry
oxygen to your heart
-Blood is supplied to the myocardium through the descending aorta through branches known as
the coronary arteries
-blood flow is reduced primarily through atherosclerosis.
-Atherosclerosis is an inflammatory process of arteries due to fibro-fatty deposits or atheroma
deposits, commonly known as cholesterol. These deposits thicken the innermost layer of the
artery and with time, close the vessel and can lead to a more severe form of cardiovascular
diseases such as myocardial infarction and congestive heart failure.
Etiology-accumulation of lipid plaque inside blood vessels impairs blood flow and blocks the oxygen
supply to the heart
Occurrence- affects 4 million people in the US. Leading cause of death after the age of 40 or 50. About
610,000 people die of heart disease in the US- that’s 1 in every 4 deaths. Mostly in African Americans,
Hispanics, Indians, and Whites

Signs/ Symptoms Risk factors Prevention

Angina/chest pain Hypertension Maintain blood pressure
Shoulder/ arm pain Tobacco use Tobacco cessation
Increased heart rate Diabetes Manage diabetes
Nausea Obesity Heathy diet
Weakness/ Dizziness Hyperlipidemia Reduce cholesterol
Shortness of breath Lack of exercise Exercise
Pain in neck/ jaw Genetics
Sweating Age 45men
Clammy skin Age 55 women

Treatments-
Surgical procedures
-Angioplasty and stent placement- procedure to remove plaque and restore blood flow
in clogged arteries
-Coronary artery bypass graft-procedure that helps restore blood flow to the heart by
routing the flow through transplanted arteries

Medications Impact on oral cavity

-Angiotensin-converting enzymes -burning mouth, taste loss, dry cough
(ACE) inhibitors
-Angiotensin receptor blockers (ARBS) -taste loss
-Anti-ischemic agents -xerostomia
-Antiplatelet drugs -prolonged bleeding
-Betablockers -xerostomia
-Calcium channel blockers -gingival enlargement
-Nitrates -xerostomia, hypotension
-Statins -xerostomia

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 Heart Disorders Anna Rusnak
Scott Sonnier
Iesha Washington

Dental Concerns
Indications
-Link between periodontal pathogens and cardiovascular disease
-RDH need to educate patients about the significant relationship between oral health and
systemic health
Contraindications
-Acute or recent myocardial infarction within the preceding 3-6 months
-Unstable or recent onset of angina pectoris
-Uncontrolled: hypertension reading 180/ 110, heart failure, and arrhythmia
- local anesthesia containing adrenaline, excesses dosing can interact with patients taking
betablockers and cause vasodilation = blood pressure drops dramatically
-Bupivacaine, avoided in patients with cardiovascular diseases =cardiotoxic
-Medications such as NSAIDS and aspirins should be avoided in patients taking ACE inhibitors
=renal disease.
-avoid ultrasonic on patients with pacemakers

Periodontal management
-Update med/dental history
-Assess vitals are below 180/110
-Patients with recent myocardial infarction or uncontrolled angina=no treatment
-Scaling/debridement are low risk procedures
-Nitroglycerin spray/ tablet easily accessible
Expected and Accepted Treatment options
-Pre-meds
Consult with cardiologist
Anti-anxiety medications/ nitroglycerin tables prior to stress-induced
Procedure to prevent angina
-Patient Positioning
Semi-supine

-Appointment length
Short, stress-free, mid-morning/ afternoon appointments= epinephrine levels peak in
early mornings
-Ultrasonic
Avoid in patients with implantable cardioverter defibrillators and
pacemakers
-Recall intervals
3 month
-Anesthesia
Epinephrine(0.04mg) safe, provides long-lasting pain control during treatment

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 Heart Disorders Anna Rusnak
Scott Sonnier
Iesha Washington

Myocardial infarction- occurs when an artery is closed off and is the most severe form of cardiovascular
disease.
-also known as heart attack
- caused by a thrombosis that blocks an artery and leads to necrosis of the tissue
-patients usually die immediately or within a few hours off an attack
-artery associated with a heart attack is the anterior descending branch of the left coronary
artery
Etiology
-Most occur because of coronary heart disease
-can occur from thrombosis, atherosclerosis, necrosis
Occurrence
-30% have symptoms
-women>men
-over 75 years of age
-1 million people have MI each year in US

Signs/Symptoms Risk factors Preventions

Pain in sternum extends to arm High blood pressure Maintain blood pressure
and neck
Cold sweats Smoking Tobacco cessation
Cyanosis Diabetes Manage diabetes
Anxiety Lack of exercise Exercise
Weakness Obesity Increase activity
Difficult breathing High cholesterol Reduce cholesterol
Loss of consciousness Poor Diet Healthy diet
Low blood pressure Excessive alcohol intake Alcohol cessation

Treatment
Surgical procedures
Angioplasty- procedure uses tiny wire with an attached balloon, that is ballooned out
into a larger artery through the groin or arm to be passed up to the heart into the
blocked coronary artery and is then blown up to open the blocked artery.
Medications Oral impact
-aspirin -increased bleeding
-heparin injections -increased bleeding
-morphine -none
-(ACE) inhibitors -burning mouth, taste loss, dry cough
-Antiplatelet drugs -prolonged bleeding
-Betablockers -xerostomia
-Calcium channel blockers -gingival enlargement
-Warfarin -increased bleeding

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 Heart Disorders Anna Rusnak
Scott Sonnier
Iesha Washington

Dental Concerns
Indications
-Prevent systemic disease, bacteremia, and periodontal disease
Contraindications
-Wait six months before getting dental treatment after heart attack
- local anesthesia containing adrenaline, excesses dosing can interact with patients taking
betablockers and cause vasodilation = blood pressure drops dramatically
-Bupivacaine, a local anesthesia should also be avoided in patients with cardiovascular diseases,
because they are cardiotoxic
-Medications such as NSAIDS and aspirins should be avoided in patients taking ACE inhibitors
=renal disease.
-avoid ultrasonic on patients with pacemakers
-Patient emergency
- Important to recognize signs of attack
- stop treatment
- sit patient up (to allow them to breath)
-administer nitroglycerin
- if pain in chest has not reduced within 3 min.
-prepare for basic life support
- call 911
-administer baby aspirin ( if not allergic)
-monitor vitals
-administer oxygen
-keep patient calm
Periodontal management
-Update med/dental history
-Assess vitals are below 180/110
-Patients with recent myocardial infarction or uncontrolled angina=no treatment
-Scaling/debridement are low risk procedures
-Nitroglycerin spray/ tablet easily accessible
Expected and Accepted Treatment options
-Pre-meds
-Consult with cardiologist
-Anti-anxiety medications/ nitroglycerin tables prior to stress-induced
procedure to prevent angina
-essential to provide a stress-free environment, limit anxiety, and pain to prevent onset
of angina pectoralis or chest pain
--prophylactic antibiotic, pravastatin, aspirin
-Patient Positioning
Semi-supine
-Appointment length
Short, stress-free, mid-morning/ afternoon appointments= epinephrine levels peak in
early mornings
-Ultrasonic
Avoid in patients with active angina or within 6 months of a heart attack
-Recall intervals- Depends on medical release from physician and last documented heart attack

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 Heart Disorders Anna Rusnak
Scott Sonnier
Iesha Washington

Congestive heart failure-

- condition associated with abnormal cardiac function or damage to the muscles
-abnormalities prevent the heart from pumping blood effectively, resulting in an inadequate
oxygen supply throughout the body
-called congestive heart failure because lung congestion and dyspnea result from it and most
common and prominent symptoms

Etiology-
-common cause coronary artery disease
-high blood pressure
-long standing alcohol abuse
-disorders of the heart valves
- results from diseases include; coronary heart disease, hypertension, diabetes, arrhythmias,
congestive heart disease, thyroid disorders, alcohol or illegal drugs, or HIV/ AIDS.
Occurrence-
-4.8 million people in U.S
-50% with 5 year life span
Signs/ Symptoms
- edema
-dyspnea
-weakness/fatigue
-light headed
-lung congestion

Treatment
- Goal is :
- Heart to beat more efficiently to meet energy need of body
- Fluid restrictions
- Decrease salt intake
- Life style changes
- Heart transplant

Medications oral impact

-Ace inhibitors --burning mouth, taste loss, dry cough
-ARBs -taste loss
-Beta blocks -xerostomia
-Digoxin -swelling of tongue

Dental Concerns
Indications
-research links periodontal disease with coronary artery disease and stroke ( not enough
evidence )

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 Heart Disorders Anna Rusnak
Scott Sonnier
Iesha Washington

Contraindications
-Wait six months before getting dental treatment after heart attack
- local anesthesia containing adrenaline, excesses dosing can interact with patients taking
betablockers and cause vasodilation = blood pressure drops dramatically
-Bupivacaine, a local anesthesia should also be avoided in patients with cardiovascular diseases,
because they are cardiotoxic
-Medications such as NSAIDS and aspirins should be avoided in patients taking ACE
inhibitors =renal disease.
-avoid ultrasonic on patients with pacemakers
Periodontal management
-Update med/dental history
-Assess vitals are below 180/110
-Patients with recent myocardial infarction or uncontrolled angina=no treatment

Expected and Accepted Treatment options

-Pre-meds
-Consult with cardiologist
-Anti-anxiety medications/ nitroglycerin tables prior to stress-induced
procedure to prevent angina
-essential to provide a stress-free environment, limit anxiety, and pain to prevent onset
of angina pectoralis or chest pain
-prophylactic antibiotic= heart disease increase risk of endocarditis
- pacemaker= prophylactic
-pravastatin, aspirin
-
-Patient Positioning
-Semi-supine
-avoid supine= fluid buildup in lungs
-Appointment length
Short appointments
-Ultrasonic
Avoid in patients with pacemakers
-Recall intervals
Regular oral hygiene visits every 6 months