Podcast
Questions and Answers
How does hypertension contribute to the development of atherosclerosis?
How does hypertension contribute to the development of atherosclerosis?
- By directly increasing cholesterol levels in the bloodstream.
- By decreasing the production of HDL, leading to increased LDL oxidation.
- By promoting the proliferation of smooth muscle cells in the artery walls.
- By causing endothelial cell damage, facilitating LDL passage into the intima. (correct)
Why do women experience an increased risk of atherosclerosis after menopause?
Why do women experience an increased risk of atherosclerosis after menopause?
- They are more likely to develop diabetes after menopause.
- They tend to adopt less healthy lifestyles as they age.
- Increased estrogen production leads to higher LDL levels.
- The protective effects of female sex hormones are diminished. (correct)
Which of the following best describes the relationship between ischemia and infarction?
Which of the following best describes the relationship between ischemia and infarction?
- Infarction is the primary cause of ischemia.
- Ischemia only occurs after an infarction has taken place.
- Ischemia can lead to infarction if blood supply is not restored. (correct)
- They are unrelated conditions affecting different organs.
What is the underlying cause of ischemic heart disease?
What is the underlying cause of ischemic heart disease?
A patient with ischemic heart disease reports experiencing jaw pain that mimics a toothache. What is the MOST appropriate initial step for the dentist?
A patient with ischemic heart disease reports experiencing jaw pain that mimics a toothache. What is the MOST appropriate initial step for the dentist?
Which of the following is a 'hard' modifiable risk factor for ischemic heart disease?
Which of the following is a 'hard' modifiable risk factor for ischemic heart disease?
A patient experiencing nausea, sweating and pain in the left arm may be suffering from:
A patient experiencing nausea, sweating and pain in the left arm may be suffering from:
A patient with stable angina needs a dental procedure. Which local anesthetic is MOST suitable, considering their condition?
A patient with stable angina needs a dental procedure. Which local anesthetic is MOST suitable, considering their condition?
What function does aspirin serve in managing ischemic heart disease?
What function does aspirin serve in managing ischemic heart disease?
A dentist is treating a patient with ischemic heart disease. During the procedure, the patient begins to experience chest pain. After stopping the treatment and calling for help, what is the MOST appropriate NEXT step?
A dentist is treating a patient with ischemic heart disease. During the procedure, the patient begins to experience chest pain. After stopping the treatment and calling for help, what is the MOST appropriate NEXT step?
A coronary angiography is being used on a patient. What does this diagnostic procedure achieve?
A coronary angiography is being used on a patient. What does this diagnostic procedure achieve?
Which appointment time is generally MOST suitable for patients with ischemic heart disease to minimize the risk of adverse cardiac events?
Which appointment time is generally MOST suitable for patients with ischemic heart disease to minimize the risk of adverse cardiac events?
A patient with unstable angina requires urgent dental treatment. What is the MOST appropriate course of action?
A patient with unstable angina requires urgent dental treatment. What is the MOST appropriate course of action?
Flashcards
Role of HDL
Role of HDL
Blocks LDL oxidation, preventing atheroma formation.
Hypertension & Atherosclerosis Link
Hypertension & Atherosclerosis Link
Damage to endothelial cells facilitates LDL passage into intima.
Ischemia
Ischemia
Reduced blood supply to tissues, causing O2 and glucose shortage.
Ischemic Heart Disease
Ischemic Heart Disease
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Common Cause of IHD
Common Cause of IHD
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Fixed IHD Risk Factors
Fixed IHD Risk Factors
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Hard Modifiable IHD Risks
Hard Modifiable IHD Risks
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IHD Symptoms
IHD Symptoms
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IHD patient: Pre-treatment steps?
IHD patient: Pre-treatment steps?
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Treating angina during treatment?
Treating angina during treatment?
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Angina emergency treatment?
Angina emergency treatment?
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What is infarction?
What is infarction?
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Chest pain during dental treatment?
Chest pain during dental treatment?
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Study Notes
- HDL plays a protective role by blocking LDL oxidation, thus hindering atheroma formation.
Hypertension and Atherosclerosis
- Hypertension-related haemodynamic forces damage endothelial cells.
- Endothelial cell damage facilitates LDL passage into the intima, leading to atherosclerosis.
Advanced Atherosclerosis
- More prevalent in males.
- After menopause, women lose the protective effects of female sex hormones, increasing their risk.
- Cigarette smoking causes endothelial cell damage.
- Diabetes increases hyperlipidaemia incidence and microvascular damage.
Consequences of Advanced Atherosclerosis
- Can lead to ischemia or infarction, which interfere with blood flow to target organs.
Ischemia Defined
- Restriction in blood supply to tissues causes a shortage of oxygen and glucose required for cellular metabolism.
Ischemic Heart Disease Defined
- Imbalance between myocardial blood supply and demand.
Causes of Ischemic Heart Disease
- Coronary atheroma: Atheromatous plaques constrict blood flow in coronary arteries.
- Increased tone in coronary vessels occasionally contributes.
Fixed Risk Factors for Ischemic Heart Disease
- Age
- Male sex
- Family history
Hard Modifiable Risk Factors for Ischemic Heart Disease
- Hyperlipidaemia
- Smoking
- Hypertension
- Diabetes
Soft Modifiable Risk Factors for Ischemic Heart Disease
- Obesity
- Sedentary lifestyle
- Alcohol consumption
- Personality traits
- Oral contraceptive use
Symptoms of Ischemic Heart Disease
- Angina
- Shortness of breath
- Nausea
- Sweating
- Pain in the right arm, neck, or jaw
Diagnosis of Ischemic Heart Disease
- Medical history
- ECG
- Coronary angiography (X-ray imaging of heart's blood vessels)
Treatment of Ischemic Heart Disease
- Modification of risk factors
- Nitrates to decrease myocardial oxygen demand and aspirin to prevent platelet adhesion
- Angioplasty with stent insertion to dilate vessels, or bypass surgery with grafts
Aspirin Use in Ischemic Heart Disease
- Prevents blood clot formation in arteries, reducing the risk of stroke or heart attack.
Ischemic Heart Disease Patient Presentation in Dental Practice
- May present as toothache or jaw pain.
Dental Management of Ischemic Heart Disease Patients
- Treatment may provoke angina or myocardial infarction, so consult with the patient's physician.
- Obtain a detailed medical history and record all medications, especially aspirin, due to bleeding risks.
- Schedule short, minimally stressful appointments, preferably late morning due to peak adrenaline levels in the morning
- Avoid general anaesthesia.
- Administer effective local anaesthesia using a self-aspirating syringe
- Be aware of medications the patient may be taking like aspirin, beta-blockers, ACE inhibitors, or calcium channel blockers.
Managing Angina During Dental Treatment
- Stable angina can be treated under adequate local anesthesia with 2% lidocaine with 1:80,000 adrenaline
- Administer GTN before treatment, avoid long procedures, and minimize stress through local anesthesia and reassurance
- Unstable angina should not be treated until it is controlled; refer the patient back to their physician
- Avoid treating patients with decubitus angina in a supine position.
Emergency Treatment of Angina During Dental Treatment
STOP treatment, reassure the patient, call for help, and position them comfortably upright
Administer sublingual GTN spray; if symptoms resolve, allow the patient to rest and send them home
If there is no response within 15 minutes, suspect unstable angina or myocardial infarction
Call emergency services Administer high-flow oxygen, GTN, and 300mg of chewed aspirin Consider relative analgesia with 50% nitrous oxide and 50% oxygen
Infarction Defined
- Tissue death caused by a lack of oxygen due to obstructed blood flow.
Peripheral Vascular Disease and Chest Pain
- Patient with peripheral vascular disease who complains of central chest pain during dental treatment may be experiencing angina leading to Ischemic Heart Disease or MI
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Description
This lesson explains the steps of atheroma formation and factors influencing it, such as HDL oxidation blockage and hypertension. It also covers advanced atherosclerosis, its prevalence in males and post-menopausal women, the impact of smoking and diabetes, and consequences like ischemia and infarction.
