Cardiovascular diseases

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Questions and Answers

Which of the following symptoms is most closely associated with heart failure?

  • Palpitations due to arrhythmia
  • Feeling faint from low blood pressure
  • Chest pain due to ischaemia
  • Breathlessness (correct)

What is the typical cause of chest pain related to heart disease?

  • Arrhythmia
  • Ischaemia (correct)
  • Heart Failure
  • Low blood pressure

Which physical sign would suggest heart failure in a clothed patient?

  • Breathlessness (correct)
  • Peripheral cyanosis only
  • High blood pressure only
  • Low body temperature

What does 'pitting' peripheral oedema indicate in the context of cardiovascular assessment?

<p>Indents on pressure (C)</p> Signup and view all the answers

What is the underlying cause of heart disease in cases of ischaemic heart disease?

<p>Coronary artery disease (A)</p> Signup and view all the answers

Atherosclerosis and thrombosis can lead to which of the following consequences?

<p>Angina and myocardial infarction (C)</p> Signup and view all the answers

What is the primary action of GTN spray in the management of angina?

<p>Vasodilation (D)</p> Signup and view all the answers

Which of the following is considered a modifiable risk factor for heart disease?

<p>Smoking (A)</p> Signup and view all the answers

What cardiac investigation is used to show changes during angina or MI, and heart rhythm?

<p>ECG (B)</p> Signup and view all the answers

Which cardiac investigation is used to detect the release of cardiac muscle proteins in acute coronary syndrome and MI?

<p>Troponin levels (A)</p> Signup and view all the answers

What is the immediate treatment for ST-elevation MI (STEMI)?

<p>Immediate coronary intervention and stent (A)</p> Signup and view all the answers

Stenosis and regurgitation are the main problems associated with which of the following?

<p>Valvular Heart Disease (A)</p> Signup and view all the answers

Rheumatic fever typically occurs after which type of infection?

<p>Streptococcal URTI (B)</p> Signup and view all the answers

Splinter haemorrhages in nails, finger clubbing, and fever are signs of which condition?

<p>Endocarditis (A)</p> Signup and view all the answers

Which treatment addresses symptoms of valvular heart disease?

<p>Anti-arrhythmics (B)</p> Signup and view all the answers

Which of the following describes the need for anticoagulation?

<p>Mechanical Valve (B)</p> Signup and view all the answers

What is the underlying issue in heart failure?

<p>The heart fails to deliver enough blood for the needs of the body (A)</p> Signup and view all the answers

Which symptoms are associated with heart failure?

<p>Breathlessness, fatigue, and oedema (C)</p> Signup and view all the answers

What may inspiratory crackles at lung bases indicate?

<p>Pulmonary oedema (D)</p> Signup and view all the answers

Which of the following is a consequence of turbulent blood flow in the heart?

<p>Murmurs (A)</p> Signup and view all the answers

What is indicated by dullness to percussion?

<p>Plural effusion/consolidation (A)</p> Signup and view all the answers

A patient presents with breathlessness at rest and pulmonary oedema. Which type of heart failure is most likely?

<p>Acute heart failure (A)</p> Signup and view all the answers

In right-sided heart failure, which of the following findings would you most likely observe?

<p>Peripheral oedema and raised JVP (C)</p> Signup and view all the answers

Understanding the implications of Cardiac MRI findings is important; however, what are common contraindications for undergoing a Cardiac MRI?

<p>Certain metallic implants in the body, such as pacemakers and defibrillators (B)</p> Signup and view all the answers

A patient has a history of rheumatic fever. Which cardiac manifestation is most closely associated with this condition?

<p>Myocarditis (Aschoff bodies) (C)</p> Signup and view all the answers

Which of the following is the primary cause of chest pain in the context of heart disease?

<p>Ischaemia (C)</p> Signup and view all the answers

What does the term 'arrhythmia' refer to in the context of cardiac symptoms?

<p>Palpitations (C)</p> Signup and view all the answers

Which of the following is a potential cause of a patient feeling faint, related to cardiovascular issues?

<p>Low blood pressure (A)</p> Signup and view all the answers

What signs might a clinician observe in a clothed patient that could suggest a cardiovascular issue?

<p>Breathlessness (B)</p> Signup and view all the answers

What assessment finding correlates with potential heart failure?

<p>Raised Jugular Venous Pressure (JVP) (B)</p> Signup and view all the answers

What does the presence of additional heart sounds, specifically murmurs, typically indicate?

<p>Turbulent blood flow (D)</p> Signup and view all the answers

What is indicated by observing 'inspiratory crackles at lung bases' during auscultation?

<p>Pulmonary Oedema (D)</p> Signup and view all the answers

What does 'dullness to percussion' typically suggest when assessing lung sounds?

<p>Pleural effusion or consolidation (A)</p> Signup and view all the answers

Which pathological process underlies ischaemic heart disease?

<p>Atherosclerosis and Thrombosis (A)</p> Signup and view all the answers

What are the potential consequences of atherosclerosis and thrombosis in the coronary arteries?

<p>Angina and Myocardial Infarction (MI) (A)</p> Signup and view all the answers

A patient is prescribed GTN spray. What is the route of administration?

<p>Sublingual (B)</p> Signup and view all the answers

Which medication is commonly used as a regular anti-anginal drug?

<p>Bisoprolol (C)</p> Signup and view all the answers

Among the following, which is a modifiable risk factor for heart disease?

<p>Smoking (C)</p> Signup and view all the answers

Which of the following is a risk factor for heart disease that cannot be modified?

<p>Age (C)</p> Signup and view all the answers

Which cardiac investigation provides real-time images of the heart's structure, movement of valves/muscle and blood flow?

<p>Echocardiogram (D)</p> Signup and view all the answers

What does a 'stress test' assess in the context of cardiac investigations?

<p>Reversible Ischaemia (A)</p> Signup and view all the answers

What does the term 'STEMI' stand for in the context of myocardial infarction?

<p>ST-elevation Myocardial Infarction (B)</p> Signup and view all the answers

What is the immediate intervention for a patient presenting with ST-elevation Myocardial Infarction (STEMI)?

<p>Immediate coronary intervention and stent (A)</p> Signup and view all the answers

What are the two main problems associated with valvular heart disease?

<p>Stenosis and Regurgitation (A)</p> Signup and view all the answers

How long after a streptococcal upper respiratory tract infection (URTI) does Rheumatic Fever typically occur?

<p>2-3 weeks (C)</p> Signup and view all the answers

Which of the following is associated with Rheumatic Fever?

<p>Arteritis (A)</p> Signup and view all the answers

What is a 'flitting' polyarthritis?

<p>An acute arthritis that migrates from joint to joint. (A)</p> Signup and view all the answers

What is the primary aim of treatments for valvular heart disease?

<p>Address symptoms of the disease. (A)</p> Signup and view all the answers

Following a valve replacement, which type of valve typically necessitates long-term anticoagulation therapy?

<p>Mechanical Valve (C)</p> Signup and view all the answers

A 78-year-old patient presents to the clinic complaining of recent onset breathlessness and fatigue, and has pitting oedema. Based on the Rotterdam study, which of the following age groups has the highest prevalence of heart failure?

<p>75-84 years (B)</p> Signup and view all the answers

Which of the following is a common cause of right-sided heart failure due to pulmonary hypertension in chronic lung disease?

<p>Cor pulmonale (B)</p> Signup and view all the answers

Which compensatory mechanism is activated in response to reduced cardiac output to retain salt and water?

<p>Activation of the renin-angiotensin-aldosterone system (C)</p> Signup and view all the answers

Which of the following is a non-cardiac cause of heart failure syndrome related to excessive demand?

<p>Arterio-venous shunts (D)</p> Signup and view all the answers

A patient presents with breathlessness due to pulmonary oedema and pulmonary venous congestion. Which of the following conditions is most likely?

<p>Heart failure (C)</p> Signup and view all the answers

Which class of medications includes drugs ending in '-opril' and is used in the pharmacological correction of heart failure?

<p>ACE inhibitors (B)</p> Signup and view all the answers

A patient is found to have a cardiac arrhythmia with a rate faster than 100 bpm and normal P waves on their ECG. Which arrhythmia is most likely?

<p>Sinus tachycardia (D)</p> Signup and view all the answers

Which of the following rhythm disturbances is characterised by uncoordinated atrial contractions, leading to a rapid, irregular ventricular rate, predisposing the patient to being anticoagulated?

<p>Atrial fibrillation (C)</p> Signup and view all the answers

A young, athletic individual is found to have a heart rate of 55 bpm during a routine check-up. Which of the following is the most likely explanation?

<p>Sinus bradycardia (D)</p> Signup and view all the answers

A patient reports occasional sensations of 'missed' or 'extra' heartbeats. Which type of intermittent rhythm disturbance is most likely?

<p>Extrasystoles (B)</p> Signup and view all the answers

Which of the following rhythm disturbances is characterised by the absence of electrical activity and contraction?

<p>Asystole (A)</p> Signup and view all the answers

Which therapeutic intervention is indicated as an emergency treatment for ventricular fibrillation?

<p>DC cardioversion (B)</p> Signup and view all the answers

Which treatment is most appropriate for a patient with bradycardia?

<p>Pacemaker (C)</p> Signup and view all the answers

For which of the following arrhythmias might an implantable defibrillator be an appropriate treatment option?

<p>Ventricular tachycardia (B)</p> Signup and view all the answers

A patient with atrial fibrillation is prescribed warfarin. What is the primary goal of this medication?

<p>To reduce the risk of stroke (B)</p> Signup and view all the answers

Which of the following would be least helpful as part of the initial investigations into heart failure?

<p>MRI of the knee (A)</p> Signup and view all the answers

A patient with a history of chronic obstructive pulmonary disease (COPD) develops right-sided heart failure. Which of the following pharmacological interventions specifically targets the underlying mechanism related to their COPD?

<p>Administering oxygen therapy to alleviate pulmonary hypertension (A)</p> Signup and view all the answers

A patient is diagnosed with heart failure and prescribed spironolactone. What is the primary mechanism of action of this medication in the context of heart failure management?

<p>Inhibition of aldosterone to reduce sodium and water retention (C)</p> Signup and view all the answers

A patient experiencing ventricular tachycardia is being managed by an implantable cardioverter-defibrillator (ICD). Under what circumstances would the ICD deliver a high-energy shock?

<p>Upon sensing a rapid, life-threatening ventricular arrhythmia (B)</p> Signup and view all the answers

A patient with atrial fibrillation is started on digoxin for rate control. What aspect of cardiac function does digoxin primarily affect to achieve this therapeutic goal?

<p>Reduces conduction through the atrioventricular (AV) node (A)</p> Signup and view all the answers

A patient with heart failure is scheduled for an elective electrophysiological study and possible catheter ablation. What is the main purpose of catheter ablation in managing certain types of arrhythmias?

<p>To modify or destroy heart tissue causing the arrhythmia (C)</p> Signup and view all the answers

In the management of atrial fibrillation, what is the rationale for using rate-controlling drugs such as beta-blockers or digoxin?

<p>To slow down the ventricular response and improve diastolic filling (C)</p> Signup and view all the answers

A patient presents with recurrent episodes of syncope due to atrio-ventricular (AV) block. What is the most definitive long-term treatment option for this condition?

<p>Insertion of a permanent pacemaker to maintain adequate heart rate (A)</p> Signup and view all the answers

A patient with a known history of ventricular tachycardia is undergoing a surgical procedure. What is the critical concern regarding the use of electrocautery equipment during the surgery?

<p>Electrical interference from electrocautery can disrupt the function of the patient's implantable defibrillator (C)</p> Signup and view all the answers

A patient receiving amiodarone for long-term management of atrial fibrillation develops new-onset pulmonary fibrosis. What is the most appropriate course of action?

<p>Discontinue amiodarone immediately and consider alternative anti-arrhythmic therapy (D)</p> Signup and view all the answers

What is a key characteristic of 'Cor Pulmonale'?

<p>Right-sided heart failure due to pulmonary hypertension from lung disease. (C)</p> Signup and view all the answers

Which of the following is a common symptom of heart failure related to fluid retention?

<p>Peripheral oedema, especially in the ankles. (C)</p> Signup and view all the answers

Which of the following blood tests is typically part of the initial investigations for heart failure?

<p>Urea &amp; Electrolytes. (A)</p> Signup and view all the answers

The activation of the renin-angiotensin-aldosterone system in heart failure leads to which physiological response?

<p>Retention of salt and water. (C)</p> Signup and view all the answers

Which class of medications is characterised by drug names ending in '-sartan' and used in heart failure management?

<p>Angiotensin II receptor blockers. (D)</p> Signup and view all the answers

A patient presents with a heart rate exceeding 100 bpm. An ECG shows normal P waves. Which arrhythmia is most likely?

<p>Sinus tachycardia. (D)</p> Signup and view all the answers

What is a primary characteristic of atrial fibrillation (AF) that often necessitates anticoagulation therapy?

<p>Uncoordinated atrial contractions, leading to a risk of thrombus formation. (B)</p> Signup and view all the answers

A young, well-trained athlete is found to have a heart rate of 55 bpm. What is the most likely underlying cause?

<p>Normal physiological adaptation. (B)</p> Signup and view all the answers

What is the typical patient description of extrasystoles?

<p>A sensation of 'missed' or 'extra' heartbeats. (B)</p> Signup and view all the answers

Which arrhythmia is characterised by a complete absence of electrical activity and cardiac muscle contraction?

<p>Asystole. (C)</p> Signup and view all the answers

What is the immediate treatment of choice for a patient in confirmed ventricular fibrillation (VF)?

<p>Prompt defibrillation. (C)</p> Signup and view all the answers

For which condition would a pacemaker be the most appropriate treatment?

<p>Bradycardia. (A)</p> Signup and view all the answers

Which of the following arrhythmias might be appropriately managed with an implantable cardioverter-defibrillator (ICD)?

<p>Ventricular fibrillation. (C)</p> Signup and view all the answers

A patient with atrial fibrillation(AF) is prescribed warfarin. What is the major goal of warfarin therapy?

<p>Prevent blood clot formation and reduce stroke risk. (A)</p> Signup and view all the answers

A patient is being investigated for breathlessness. Which test from the following list is least helpful in the diagnosis of heart failure?

<p>Bronchoscopy. (C)</p> Signup and view all the answers

A patient with COPD develops right-sided heart failure. Which treatment targets the underlying mechanism related to their COPD?

<p>Oxygen therapy to correct hypoxia-induced pulmonary hypertension (C)</p> Signup and view all the answers

A diagnosed heart failure patient is prescribed spironolactone. What is its primary action in the context of heart failure management?

<p>Blocking aldosterone to reduce sodium and water retention (A)</p> Signup and view all the answers

An ICD delivers a high-energy shock after detecting ventricular tachycardia. What triggers the ICD to deliver this shock?

<p>Detection of rapid, irregular ventricular rhythm (C)</p> Signup and view all the answers

A patient with atrial fibrillation is started on digoxin. What is the primary mechanism by which digoxin achieves rate control?

<p>Slowing conduction through the AV node (D)</p> Signup and view all the answers

What is the main purpose of catheter ablation as a treatment for certain types of arrhythmias?

<p>Creating scar tissue to block abnormal electrical pathways (B)</p> Signup and view all the answers

What is the rationale for using rate-controlling drugs in atrial fibrillation?

<p>To slow the ventricular response and alleviate symptoms. (C)</p> Signup and view all the answers

What is the definitive long-term treatment for recurrent syncope due to complete heart block?

<p>Implantation of a permanent pacemaker (C)</p> Signup and view all the answers

A patient with ventricular tachycardia is undergoing surgery. Why is there a concern regarding the use of electrocautery equipment?

<p>It may cause electrical interference with implanted devices (D)</p> Signup and view all the answers

A patient on amiodarone develops new-onset pulmonary fibrosis. What is the immediate next step to take?

<p>Immediately discontinue amiodarone (B)</p> Signup and view all the answers

Imagine a scenario where the sino-atrial (SA) node is firing at a rate of 72 beats per minute (bpm), but the atrioventricular (AV) node only conducts every other impulse. What would be the resulting ventricular heart rate?

<p>36 bpm (B)</p> Signup and view all the answers

According to SDCEP guidelines regarding anticoagulation, what is generally recommended for patients taking DOACs?

<p>Usually there is no need to stop DOACs; utilize local haemostatic measures. (D)</p> Signup and view all the answers

For patients on warfarin therapy undergoing minor procedures, what INR level is generally considered acceptable to proceed, alongside local haemostatic measures?

<p>INR &lt; 4.0 (C)</p> Signup and view all the answers

According to the previous standard, what blood pressure reading typically indicates hypertension?

<p>140/90 mmHg or higher (B)</p> Signup and view all the answers

When measuring blood pressure in a clinic, what is the recommended approach for ensuring accuracy?

<p>Take at least two measurements and average the readings. (A)</p> Signup and view all the answers

What is the 'white coat effect' in the context of blood pressure measurement?

<p>Elevated blood pressure readings due to anxiety in a clinical setting. (B)</p> Signup and view all the answers

What proportion of hypertension cases are classified as 'essential' hypertension?

<p>90% (B)</p> Signup and view all the answers

Which of the following is considered an environmental factor contributing to essential hypertension?

<p>High salt intake (C)</p> Signup and view all the answers

Secondary hypertension is suspected in what percentage of hypertension cases?

<p>10% (D)</p> Signup and view all the answers

In which of the following scenarios should clinicians particularly investigate the possibility of secondary hypertension?

<p>In young patients with very high or poorly controlled blood pressure. (B)</p> Signup and view all the answers

Which of the following is the most common cause of secondary hypertension?

<p>Renal causes (D)</p> Signup and view all the answers

Which of the following endocrine disorders is a known cause of secondary hypertension?

<p>Conn's syndrome (D)</p> Signup and view all the answers

A patient presents with central obesity, striae, and hypertension. Which endocrine disorder should be suspected?

<p>Cushing's syndrome (C)</p> Signup and view all the answers

A patient presents with postural hypotension, headaches, and hypertension. Which of the following conditions may be suspected?

<p>Pheochromocytoma (C)</p> Signup and view all the answers

Which of the following is a potential cardiovascular effect of sustained elevated blood pressure?

<p>Increased risk of cerebral infarction (C)</p> Signup and view all the answers

Which ocular change can occur as a consequence of chronic hypertension?

<p>Attenuation of blood vessels (D)</p> Signup and view all the answers

Which of the following is a potential consequence of uncontrolled hypertension affecting the brain?

<p>Hypertensive encephalopathy (C)</p> Signup and view all the answers

Which common oral side effect is associated with the use of nifedipine or amlodipine?

<p>Gingival hyperplasia (D)</p> Signup and view all the answers

Which of the following cardiovascular drugs is known to cause lichenoid drug reactions?

<p>Atenolol (A)</p> Signup and view all the answers

What is the most frequent symptom observed in infective endocarditis (IE)?

<p>Pyrexia (A)</p> Signup and view all the answers

In approximately what percentage of infective endocarditis cases does the infection affect the left side of the heart?

<p>95% (B)</p> Signup and view all the answers

Which heart valve is most commonly affected in right-sided endocarditis among intravenous drug abusers?

<p>Tricuspid valve (D)</p> Signup and view all the answers

Which microorganism is most often the cause of acute infective endocarditis affecting both normal and abnormal valves?

<p><em>Staphylococcus aureus</em> (C)</p> Signup and view all the answers

What is the approximate mortality rate associated with right-sided endocarditis in intravenous drug abusers?

<p>10% (A)</p> Signup and view all the answers

In native valve bacterial endocarditis, what is the most common bacterial cause according to the pie chart?

<p>Staphylococci (D)</p> Signup and view all the answers

What is the primary strategy for managing a patient with endocarditis complicated by abscess formation in the heart, congestive heart failure and neurological dysfunction?

<p>Surgical intervention with antibiotics (D)</p> Signup and view all the answers

According to SDCEP guidelines, what is the general recommendation for patients taking DOACs who require a minor procedure?

<p>There is usually no need to stop DOACs; employ local haemostatic measures. (B)</p> Signup and view all the answers

For patients on warfarin therapy undergoing minor procedures, what INR level is generally considered acceptable to proceed, assuming local haemostatic measures are also used?

<p>INR &lt; 4.0 (C)</p> Signup and view all the answers

According to the previous standard, what blood pressure reading would typically indicate hypertension?

<p>140/90 mmHg or higher (B)</p> Signup and view all the answers

In native valve bacterial endocarditis, which bacterial genus accounts for approximately 50% of cases?

<p>Staphylococci (B)</p> Signup and view all the answers

What is the primary strategy for managing a patient with endocarditis complicated by vegetation formation, congestive heart failure and neurological dysfunction?

<p>Surgical intervention (A)</p> Signup and view all the answers

Which cardiac feature is commonly associated with infective endocarditis (IE)?

<p>Changing murmurs (B)</p> Signup and view all the answers

What is an embolic event related to infective endocarditis?

<p>Arterial blockage due to septic emboli (C)</p> Signup and view all the answers

Which of the following signs is associated with Osler's nodes?

<p>Red-purple, raised, tender lumps on fingers or toes (C)</p> Signup and view all the answers

What is a key diagnostic criterion for infective endocarditis (IE)?

<p>Positive blood cultures and echocardiogram findings (C)</p> Signup and view all the answers

According to the modified Duke criteria, what combination of findings would classify a patient as having 'definite' infective endocarditis (IE)?

<p>One major and three minor criteria. (B)</p> Signup and view all the answers

What guides the selection of antimicrobial treatment for infective endocarditis (IE)?

<p>Pathogen isolated from cultures (D)</p> Signup and view all the answers

Which of the following best describes why antibiotic prophylaxis is considered in the context of dental procedures and infective endocarditis (IE)?

<p>To protect those at increased risk of IE from bacteraemia-induced infection. (A)</p> Signup and view all the answers

According to the NICE guidelines, is antibiotic prophylaxis routinely recommended for individuals undergoing dental procedures to prevent infective endocarditis?

<p>Not routinely recommended. (A)</p> Signup and view all the answers

Which patient group is considered at high risk of developing infective endocarditis (IE) according to SDCEP guidelines?

<p>Patients with previous IE. (A)</p> Signup and view all the answers

According to SDCEP guidelines, a patient with a history of rheumatic fever would be classified as which risk category for infective endocarditis (IE)?

<p>Moderate risk (B)</p> Signup and view all the answers

A patient undergoing dental treatment is at 'high risk' of IE. What does SDCEP recommend a dental practitioner focus on?

<p>Ensuring optimal oral hygiene. (A)</p> Signup and view all the answers

A 62-year-old patient presents with a new heart murmur, fever, and fatigue. Which of the following conditions should be highly suspected?

<p>Infective endocarditis (B)</p> Signup and view all the answers

A patient with suspected infective endocarditis has absent pulses in their left leg. What is the most likely explanation?

<p>Septic emboli (D)</p> Signup and view all the answers

A patient presents with small, non-tender hemorrhagic lesions on the palms of their hands and soles of their feet. These lesions are most likely:

<p>Janeway lesions (C)</p> Signup and view all the answers

A clinician suspects infective endocarditis in a patient. Initial investigations should include:

<p>Clinical features, blood cultures, and imaging (A)</p> Signup and view all the answers

During a general examination of a patient, which physical sign might suggest infective endocarditis?

<p>Skin lesions and tachycardia (D)</p> Signup and view all the answers

A patient is diagnosed with IE. Blood cultures come back negative. What percentage of IE are blood cultures typically negative in?

<p>Around 14% (C)</p> Signup and view all the answers

Which of the following is considered a MAJOR criterion in the Duke Criteria for IE?

<p>Evidence of endocardial involvement (A)</p> Signup and view all the answers

According to the SDCEP guidelines, which website should a healthcare professional visit for more information?

<p><a href="http://www.sdcep.org.uk">www.sdcep.org.uk</a> (D)</p> Signup and view all the answers

Which of the following factors influencing oral health is directly addressed in the SDCEP guidelines concerning infective endocarditis (IE)?

<p>The importance of good oral hygiene. (C)</p> Signup and view all the answers

A patient with suspected IE develops sudden unilateral blindness. What is the likely underlying mechanism?

<p>Embolic occlusion of retinal vessels. (A)</p> Signup and view all the answers

A patient presents with glomerulonephritis and is suspected of having a condition associated with immune complexes. What key signs would further lead to a diagnosis?

<p>Glomerulonephritis -&gt; loin pain, haematuria (D)</p> Signup and view all the answers

In the context of managing a patient with infective endocarditis (IE), why is identifying the specific causative microorganism through blood cultures critically important?

<p>To guide the selection of the most appropriate antimicrobial treatment regimen. (C)</p> Signup and view all the answers

A patient with prosthetic valve replacement develops a fever, new murmur and splinter hemorrhages. Blood cultures grow Streptococcus viridans. An echocardiogram shows a perivalvular abscess. Despite appropriate IV antibiotic therapy, the patient develops worsening heart failure. What is the most appropriate next step in management?

<p>Valve replacement surgery (E)</p> Signup and view all the answers

A 23-year-old intravenous drug user presents with fever, shortness of breath, and chest pain. On examination, you note a new murmur. What initial step is most critical in the management of this patient?

<p>Draw blood cultures (A)</p> Signup and view all the answers

Which cardiac manifestation is commonly associated with infective endocarditis (IE)?

<p>Deteriorating valve function (D)</p> Signup and view all the answers

What is a potential embolic consequence of infective endocarditis affecting the left side of the heart?

<p>Cerebral infarction resulting in neurological deficits (D)</p> Signup and view all the answers

Osler's nodes are characterised by which of the following?

<p>Painful, red-purple nodules on the pads of the fingers and toes (A)</p> Signup and view all the answers

Which combination of findings meets the criteria for 'definite' infective endocarditis (IE) according to the modified Duke criteria?

<p>Two major criteria, or one major criterion and three minor criteria, or five minor criteria (B)</p> Signup and view all the answers

What is the primary determinant in selecting antimicrobial treatment for infective endocarditis (IE)?

<p>Causative microorganism identified from blood cultures and its antibiotic sensitivities (D)</p> Signup and view all the answers

Generally speaking, why is antibiotic prophylaxis considered in some dental procedures for high-risk patients?

<p>To mitigate potential bacteremia resulting from the procedure (D)</p> Signup and view all the answers

According to NICE guidelines, what is the current recommendation regarding antibiotic prophylaxis for dental procedures to prevent infective endocarditis (IE)?

<p>Antibiotic prophylaxis is not routinely recommended for individuals undergoing dental procedures (C)</p> Signup and view all the answers

According to SDCEP guidelines, which patient group is considered at high risk of developing infective endocarditis (IE)?

<p>Patients with previous IE (B)</p> Signup and view all the answers

According to SDCEP guidelines, how would a patient with a history of rheumatic fever be classified in terms of IE risk?

<p>Moderate risk (D)</p> Signup and view all the answers

According to SDCEP, what primary area should dental practitioners concentrate on when treating a patient at 'high risk' of IE?

<p>Maintaining the highest standards of oral health (B)</p> Signup and view all the answers

A patient is diagnosed with IE. Blood cultures come back negative. In what percentage of IE cases are blood cultures typically negative?

<p>14% (A)</p> Signup and view all the answers

According to the SDCEP guidelines, which website can a healthcare professional visit for further information related to IE?

<p><a href="http://www.sdcep.org.uk">www.sdcep.org.uk</a> (B)</p> Signup and view all the answers

A patient presents with glomerulonephritis and is suspected of having a condition associated with immune complexes. What key signs would further lead to a diagnosis of infective endocarditis?

<p>New heart Murmur, Fever, and Skin Manifestations (A)</p> Signup and view all the answers

According to the information, what activity presents a greater risk of infective endocarditis (IE) than a single dental procedure?

<p>Regular tooth brushing. (C)</p> Signup and view all the answers

Other than benefits and risks, what should healthcare professionals offer people clear and consistent advice about regarding infective endocarditis?

<p>The importance of maintaining good oral health. (A)</p> Signup and view all the answers

For bacteraemia producing dental procedures, antibiotic prophylaxis is:

<p>Not routinely indicated. (C)</p> Signup and view all the answers

What is the potential negative outcome of antibiotic prophylaxis against infective endocarditis (IE) for dental procedures based on the information?

<p>It may lead to a net loss of life. (A)</p> Signup and view all the answers

What point is made about awareness of cardiovascular disorders, in relation to clinical practice?

<p>It is important for safe clinical practice. (A)</p> Signup and view all the answers

What should practitioners do when in doubt about managing a patient at risk of IE?

<p>Liaise with experienced colleagues or specialists. (A)</p> Signup and view all the answers

What factor decreases confidence in prescribing antibiotics for prophylaxis?

<p>The clinical effectiveness of antibiotic prophylaxis is not proven. (B)</p> Signup and view all the answers

Besides good oral health, what other invasive procedure should healthcare professionals give advice about?

<p>Body piercing or tattooing. (B)</p> Signup and view all the answers

There are certain 'subtleties' to the debate about prescribing antibiotic prophylaxis - what does this suggest?

<p>Individual circumstances and risk factors may warrant careful consideration. (A)</p> Signup and view all the answers

If the SA node is firing normally, but the AV node only lets every third impulse through completely at random, what conduction ratio is this?

<p>3:1 AV block as every third atrial impulse is conducted. (D)</p> Signup and view all the answers

Why is antibiotic prophylaxis not routinely indicated for bacteraemia-producing dental procedures?

<p>Its clinical effectiveness is not proven, and may lead to a net loss of life. (D)</p> Signup and view all the answers

What activity presents a greater risk of infective endocarditis than a single dental procedure?

<p>Regular tooth brushing. (A)</p> Signup and view all the answers

In the context of preventing infective endocarditis, what consistent and clear advice should healthcare professionals offer?

<p>Benefits, risks, the importance of good oral health, symptoms of IE, and risks of invasive procedures such as body piercing or tattooing. (D)</p> Signup and view all the answers

A dentist is unsure about managing a patient at risk of infective endocarditis. What should they do?

<p>Liaise with a specialist or seek expert advice. (D)</p> Signup and view all the answers

Why does the current SDCEP guidance suggest that antibiotic prophylaxis is not routinely indicated for bacteraemia-producing dental procedures?

<p>Studies show it has limited clinical effectiveness and may contribute to antibiotic resistance. (A)</p> Signup and view all the answers

Aside from good oral health, what other invasive procedure should patients receive advice about in relation to infective endocarditis (IE)?

<p>Body piercing or tattooing. (B)</p> Signup and view all the answers

How does a working knowledge of cardiovascular disorders and potential complications influence clinical dental practice?

<p>It is essential for providing safe and appropriate patient care. (A)</p> Signup and view all the answers

What is the primary implication of the statement that 'there are subtleties to the debate' about prescribing antibiotic prophylaxis?

<p>Each case needs individual consideration, and blanket rules may not always apply. (B)</p> Signup and view all the answers

Which of the following scenarios would most likely create decreased confidence in prescribing antibiotics for prophylaxis?

<p>Increasing rates of antibiotic resistance and limited evidence of benefit. (C)</p> Signup and view all the answers

Regarding the statement, 'Endocarditis is a disease with which dental practitioners need to be familiar', what represents the MOST important responsibility for a practitioner?

<p>Remaining informed about current best practices and guidelines to minimise patient risk. (C)</p> Signup and view all the answers

In a clothed patient, which of the following signs could indicate a cardiovascular issue?

<p>Breathlessness (D)</p> Signup and view all the answers

What is a symptom of heart disease unrelated to ischaemia?

<p>Breathlessness (C)</p> Signup and view all the answers

What are typical symptoms of heart failure?

<p>Ankle Swelling, Breathlessness and Fatigue (B)</p> Signup and view all the answers

A patient reports experiencing heart palpitations. What cardiovascular issue does this suggest?

<p>Arrhythmia (C)</p> Signup and view all the answers

What does a raised Jugular Venous Pressure (JVP) typically indicate?

<p>Heart Failure (D)</p> Signup and view all the answers

What pathological processes underlie ischaemic heart disease?

<p>Atherosclerosis &amp; Thrombosis (A)</p> Signup and view all the answers

Which medication class is commonly used to provide immediate relief during an angina attack?

<p>GTN Spray (D)</p> Signup and view all the answers

What is the primary purpose of performing a coronary angiogram?

<p>Guiding Invasive Intervention (A)</p> Signup and view all the answers

What is the goal when administering aspirin to a patient during a myocardial infarction?

<p>Inhibit Platelet Aggregation (D)</p> Signup and view all the answers

Within the context of valvular heart disease, what two primary issues arise?

<p>Stenosis &amp; Regurgitation (A)</p> Signup and view all the answers

How long after a streptococcal infection does rheumatic fever typically develop?

<p>2-3 weeks (D)</p> Signup and view all the answers

What is the significance of 'flitting' polyarthritis in the diagnosis of Rheumatic Fever?

<p>Suggestive of Rheumatic Fever (B)</p> Signup and view all the answers

What is the main objective regarding treatments for valvular heart disease?

<p>Addressing the Symptoms (B)</p> Signup and view all the answers

Post valve replacement, what consideration is most important?

<p>Anticoagulation Needs (C)</p> Signup and view all the answers

What are the common causes of right-sided heart failure?

<p>Cor Pulmonale (C)</p> Signup and view all the answers

Which physiological response is triggered during heart failure to retain fluid, and also to increase blood pressure and cardiac output?

<p>The Renin-Angiotensin-Aldosterone System (C)</p> Signup and view all the answers

Which of the following is a non-cardiac cause of heart failure related to excessive demand on the heart?

<p>Hyperthyroidism (A)</p> Signup and view all the answers

A patient has normal P waves and a heart rate above 100 bpm. Which arrhythmia is likely?

<p>Sinus Tachycardia (D)</p> Signup and view all the answers

What is the primary goal of administering warfarin to a patient with atrial fibrillation?

<p>Prevent Thrombus formation (B)</p> Signup and view all the answers

What is a typical finding in healthy, young athletes?

<p>Sinus Bradycardia (D)</p> Signup and view all the answers

A patient reports symptoms that align to extrasystoles. How might they describe this?

<p>A Sensation of Missed or Extra Heartbeats (B)</p> Signup and view all the answers

Which arrhythmia is marked by the absence of electrical activity and contraction?

<p>Asystole (A)</p> Signup and view all the answers

What intervention should be immediately performed in a patient with ventricular fibrillation?

<p>Performing Electrical Cardioversion (D)</p> Signup and view all the answers

What intervention should be immediately performed in a patient with bradycardia?

<p>Pacemaker (C)</p> Signup and view all the answers

For which arrhythmia might an implantable defibrillator be the most appropriate therapy?

<p>Ventricular Tachycardia (C)</p> Signup and view all the answers

When using electrocautery equipment during surgery, what is the main concern for a patient with an implantable cardioverter-defibrillator?

<p>Electrical Interference (A)</p> Signup and view all the answers

A patient receiving amiodarone for atrial fibrillation develops pulmonary fibrosis. What step follows?

<p>Discontinue Amiodarone (D)</p> Signup and view all the answers

A patient previously had a blood pressure reading of 160/100 mmHg. According to the previous standard, what would this indicate?

<p>Hypertension (B)</p> Signup and view all the answers

What methods should be used to measure accurate blood pressure in a clinic?

<p>Multiple Measurements in a Seated Position (D)</p> Signup and view all the answers

What is the definition of the 'white coat effect' in blood pressure measurements?

<p>Elevated Readings in a Medical Setting (B)</p> Signup and view all the answers

In what proportion of hypertension cases is the cause classified as 'essential' hypertension?

<p>90% (D)</p> Signup and view all the answers

Which of the following is an environmental factor that has been linked to development of hypertension?

<p>Obesity (B)</p> Signup and view all the answers

What percentage of cases are classified as secondary hypertension?

<p>approximately 10% (C)</p> Signup and view all the answers

In which scenario should clinicians be suspicious that the patient may be experiencing secondary hypertension?

<p>Poorly Controlled Blood Pressure in a Young patient (C)</p> Signup and view all the answers

A patient exhibits central obesity, presence of striae, and hypertension. Which endocrine disorder should the clinician suspect?

<p>Cushing's syndrome (C)</p> Signup and view all the answers

A patient exhibits postural hypotension, headaches, and hypertension. Which of the following conditions may be suspected?

<p>Phaeochromocytoma (B)</p> Signup and view all the answers

What is a possible cardiovascular effect of sustained elevated blood pressure?

<p>Increased risk of CHD (D)</p> Signup and view all the answers

What eye changes might occur as a consequence of chronic hypertension?

<p>Blood vessels attenuated (D)</p> Signup and view all the answers

What is a common oral side effect that can coincide with the use of amlodipine?

<p>Gingival Hyperplasia (A)</p> Signup and view all the answers

Which cardiovascular drug is known to cause lichenoid drug reaction?

<p>Atenolol (A)</p> Signup and view all the answers

What is a patient's most frequent symptom if they are diagnosed with infective endocarditis (IE)?

<p>Pyrexia (A)</p> Signup and view all the answers

Most of infective endocarditis cases affect which side of the heart?

<p>Left Side (A)</p> Signup and view all the answers

Which valve is most commonly affected in right-sided endocarditis among intravenous drug abusers?

<p>Tricuspid Valve (C)</p> Signup and view all the answers

According to SDCEP, what should dental practitioners focus on as part of an appointment for patients at 'high risk' of infective endocarditis?

<p>Importance of good oral health (D)</p> Signup and view all the answers

In the context of cardiovascular signs, what is suggested by the presence of pallor?

<p>Anemia or reduced peripheral blood flow. (C)</p> Signup and view all the answers

A patient has a diagnosis of heart disease. Their main complaint is ankle swelling. Which of the following is the most appropriate course of action?

<p>Investigate for potential heart failure. (A)</p> Signup and view all the answers

During auscultation of a patient's chest, a clinician notes a 'wheezing' sound. In what circumstance could this be related to heart disease?

<p>Cardiac asthma due to pulmonary congestion. (D)</p> Signup and view all the answers

A patient presents with heart disease symptoms, and central cyanosis is observed. What does central cyanosis indicate?

<p>Reduced oxygen saturation in arterial blood. (C)</p> Signup and view all the answers

Which of the following best describes the underlying mechanism of angina pectoris?

<p>Myocardial ischaemia (C)</p> Signup and view all the answers

What is the primary reason for using nitrates in the management of angina?

<p>To reduce blood pressure by vasodilation (B)</p> Signup and view all the answers

A patient is diagnosed with Acute Coronary Syndrome. What initial blood marker is most indicative of myocardial damage?

<p>Troponin (D)</p> Signup and view all the answers

What is the usual pathway for managing ST-Elevation Myocardial Infarction (STEMI)?

<p>Immediate transfer to a centre capable of performing percutaneous coronary intervention (PCI). (A)</p> Signup and view all the answers

Why does stenosis of a heart valve lead to increased cardiac workload?

<p>By obstructing forward flow, forcing the heart to pump harder (D)</p> Signup and view all the answers

What is the primary reason for needing anticoagulation with a mechanical heart valve?

<p>To prevent thrombus formation on the valve surface (B)</p> Signup and view all the answers

According to prevalence from the Rotterdam Study, which age range exhibits highest rate of heart failure?

<p>75-84 years (D)</p> Signup and view all the answers

How does chronic lung disease leads to pulmonary hypertension and right-sided heart failure?

<p>Increasing resistance in the pulmonary circulation (C)</p> Signup and view all the answers

What is the physiological effect of the renin-angiotensin-aldosterone system (RAAS) activation in heart failure?

<p>Increasing sodium and water retention (D)</p> Signup and view all the answers

Which sign is commonly observed in a patient experiencing right-sided heart failure?

<p>Raised JVP (B)</p> Signup and view all the answers

Based on slide 23, which of the following is an example of a non-cardiac cause of heart failure related to fluid overload?

<p>Intravenous therapy (A)</p> Signup and view all the answers

Which class of drugs used in heart failure affects the RAAS system and ends in '-sartan'?

<p>Angiotensin II receptor blockers (B)</p> Signup and view all the answers

In the context of cardiac arrhythmias, what distinguishes sinus tachycardia from other tachycardias?

<p>Normal P waves (B)</p> Signup and view all the answers

A patient has irregularly irregular pulse, increasing the risk of stroke. What is the underlying mechanism for prescribing anticoagulation?

<p>Preventing thromboembolism (A)</p> Signup and view all the answers

A young, athletic individual has bradycardia. What could be a physiological explanation?

<p>Increased vagal tone (B)</p> Signup and view all the answers

A patient is given a diagnosis of extrasystoles. How would this be described?

<p>Sensation of missed or extra heartbeats (D)</p> Signup and view all the answers

What is the underlying issue for cardiac arrest due to ventricular fibrillation?

<p>Lack of effective cardiac output (B)</p> Signup and view all the answers

Which of the following is a treatment for ventricular fibrillation?

<p>DC cardioversion (D)</p> Signup and view all the answers

A patient requires a pacemaker. What is the most likely type of arrhythmia?

<p>Bradycardia (B)</p> Signup and view all the answers

What is the purpose of implantable cardioverter-defibrillators (ICDs)?

<p>Delivering an electrical shock to treat life-threatening tachycardias (VT or VF) (B)</p> Signup and view all the answers

How does warfarin reduce the risk of stroke in atrial fibrillation?

<p>Preventing thromboembolism (A)</p> Signup and view all the answers

Which blood pressure reading constitutes hypertension, according to the previous standard?

<p>Above 140/90 mmHg (D)</p> Signup and view all the answers

What step is recommended when measuring blood pressure to ensure accuracy?

<p>Averaging 2 readings whilst sitting (A)</p> Signup and view all the answers

What is the 'white coat effect' in blood pressure measurement?

<p>Elevated blood pressure in a clinical setting (A)</p> Signup and view all the answers

What percentage of hypertension cases are classified as 'essential' hypertension?

<p>90% (C)</p> Signup and view all the answers

Which environmental factor significantly contributes to essential hypertension?

<p>Obesity, salt intake and lack of exercise (C)</p> Signup and view all the answers

Under what conditions should secondary hypertension be highly suspected and investigated?

<p>If BP is very high or poorly controlled in a young patient (D)</p> Signup and view all the answers

What is renal artery stenosis?

<p>Reduced blood flow due to blocked artery (C)</p> Signup and view all the answers

Conn's syndrome can cause secondary hypertension. What is the underlying issue of Conn's syndrome?

<p>Increased aldosterone production (D)</p> Signup and view all the answers

A patient presents with central obesity, striae, and hypertension. Which endocrine disorder should always be suspected in such cases?

<p>Cushing's syndrome (A)</p> Signup and view all the answers

A patient shows postural hypotension, headaches, and hypertension. What condition is suspected?

<p>Phaeochromocytoma (A)</p> Signup and view all the answers

Which cardiovascular effect can chronic untreated hypertension cause?

<p>Increased blood pressure (D)</p> Signup and view all the answers

What ocular change can occur because of long-standing hypertension?

<p>Blood vessel attenuation and hemorrhages (C)</p> Signup and view all the answers

Uncontrolled chronic hypertension carries several risks - what can happen to the brain vessels?

<p>Increased risk of stroke (C)</p> Signup and view all the answers

What common side effect is associated with calcium channel blockers such as nifedipine or amlodipine?

<p>Gingival hyperplasia (B)</p> Signup and view all the answers

Which cardiovascular drug could trigger lichenoid drug reactions?

<p>Atenolol (C)</p> Signup and view all the answers

What is the most frequent symptom in infective endocarditis (IE)?

<p>Pyrexia (C)</p> Signup and view all the answers

Native valve bacterial endocarditis is caused by which bacterial genus in approximately 50% of cases?

<p>Streptococci (A)</p> Signup and view all the answers

According to SDCEP guidelines, what action is required for a patient taking DOACs who requires low-risk treatment?

<p>Usually no need to stop DOACs (D)</p> Signup and view all the answers

What invasive procedure should patients be given clear advice about, besides good oral health?

<p>Body piercing or tattooing (C)</p> Signup and view all the answers

What should practitioners do if they are unsure?

<p>Liaise if in doubt (C)</p> Signup and view all the answers

Which is the most definitive factor influencing decision making in clinical dental practice regarding cardiovascular disorders and potential complications?

<p>A working knowledge of cardiovascular disorders and potential complications. (A)</p> Signup and view all the answers

What is the most common cause of breathlessness related to the heart?

<p>Heart failure (C)</p> Signup and view all the answers

Which of the following is a sign of heart failure observable in a clothed patient?

<p>Breathlessness (D)</p> Signup and view all the answers

What pathological processes directly contribute to ischaemic heart disease?

<p>Atherosclerosis and thrombosis (A)</p> Signup and view all the answers

Which cardiac investigation provides a real-time moving image of the heart?

<p>Echocardiogram (D)</p> Signup and view all the answers

Why is a patient with Atrial Fibrillation (AF) often prescribed anticoagulation medication such as Warfarin?

<p>To reduce the risk of stroke from thrombus embolisation (D)</p> Signup and view all the answers

A patient with known cardiovascular disease presents with significant postural hypotension and episodic headaches. Which of the following underlying secondary causes of hypertension should be suspected?

<p>Phaeochromocytoma (A)</p> Signup and view all the answers

A young, otherwise healthy, male patient has a blood pressure reading of 150/95 mmHg during a routine check-up. According to current guidelines, what is the MOST important next step in managing this patient?

<p>Advise lifestyle modifications and reassess blood pressure on multiple occasions (C)</p> Signup and view all the answers

Which factor decreases confidence in prescribing antibiotics for dental prophylaxis specifically?

<p>The clinical effectiveness of antibiotic prophylaxis is not proven. (A)</p> Signup and view all the answers

A patient presents with glomerulonephritis. In the context of infective endocarditis (IE) and immune complexes, what additional clinical findings would most strongly suggest a diagnosis of IE as the underlying cause of the renal condition?

<p>New heart murmur, fever, and splinter haemorrhages (A)</p> Signup and view all the answers

Why might an implantable cardioverter-defibrillator (ICD) be surgically implanted?

<p>To 'shock' the heart out of ventricular fibrillation or ventricular tachycardia (B)</p> Signup and view all the answers

What cardiac issue is most frequently attributed to ischaemia?

<p>Chest pain (C)</p> Signup and view all the answers

Other than respiratory issues, what is another cause of breathlessness?

<p>Heart failure (D)</p> Signup and view all the answers

Which of the following signs in a clothed patient may indicate a cardiovascular problem?

<p>Peripheral oedema (C)</p> Signup and view all the answers

Inspiratory crackles can indicate pulmonary oedema; however, what do reduced breath sounds and dullness to percussion indicate?

<p>Pleural effusion or consolidation (C)</p> Signup and view all the answers

What are the consequences of ischaemic heart disease?

<p>Angina and myocardial infarction (D)</p> Signup and view all the answers

What is the route of GTN spray administration?

<p>Sublingual (B)</p> Signup and view all the answers

Which of the following is an example of a regular anti-anginal drug?

<p>Bisoprolol (D)</p> Signup and view all the answers

Which of the following is a non-modifiable risk factor for heart disease?

<p>Age (B)</p> Signup and view all the answers

Which of the following statements best describes the use of chest X-rays in cardiac investigations?

<p>They detect heart enlargement and pulmonary oedema (A)</p> Signup and view all the answers

Which invasive cardiac investigation is used to help guide intervention?

<p>Coronary angiogram (B)</p> Signup and view all the answers

What heart structures are affected in valvular heart disease?

<p>Mitral, aortic, tricuspid, pulmonary (A)</p> Signup and view all the answers

What heart conditions are associated with Rheumatic Fever?

<p>Endocarditis, myocarditis, pericarditis (D)</p> Signup and view all the answers

What sign indicates endocarditis?

<p>Splinter haemorrhages in nails (A)</p> Signup and view all the answers

What type of valve replacement requires more durable anticoagulation?

<p>Mechanical valve (A)</p> Signup and view all the answers

What are the main components of heart failure?

<p>Breathlessness, fatigue and oedema (C)</p> Signup and view all the answers

According to the Rotterdam study, which age group has the highest prevalence of heart failure?

<p>75-84 years (B)</p> Signup and view all the answers

In right-sided heart failure, what physical exam finding would you MOST likely observe?

<p>Raised JVP (A)</p> Signup and view all the answers

Which of the following is an example of non-cardiac cause of heart failure?

<p>Renal injury (C)</p> Signup and view all the answers

Which medications are categorised by drug names ending in “-opril?”

<p>ACE inhibitors (C)</p> Signup and view all the answers

Which is the most common type of rhythm disturbance?

<p>Atrial fibrillation (B)</p> Signup and view all the answers

A young athlete is found to have a heart rate of 55 bpm. Why?

<p>Normal sinus bradycardia (D)</p> Signup and view all the answers

Which of the following statements is true regarding ventricular fibrillation?

<p>It has no cardiac output and is a cardiac arrest. (B)</p> Signup and view all the answers

Which cardiac event is not ‘shockable’?

<p>Asystole (A)</p> Signup and view all the answers

Which therapeutic intervention is MOST appropriate for a patient with bradycardia?

<p>Pacemaker insertion (D)</p> Signup and view all the answers

When is anticoagulation needed?

<p>Atrial fibrillation (C)</p> Signup and view all the answers

Activating the renin-angiotensin-aldosterone system to retain salt and water, is a compensatory mechanism for which cardiovascular issue?

<p>Reduced cardiac output (A)</p> Signup and view all the answers

What blood pressure reading previously typically indicated hypertension?

<p>140/90 (B)</p> Signup and view all the answers

What technique might be applied when taking blood pressure, to provide accurate measurements?

<p>Take two measurements and take an average (B)</p> Signup and view all the answers

Around what percentage of hypertension cases are deemed ‘essential’ hypertension?

<p>90% (C)</p> Signup and view all the answers

Which sign is associated with Cushing’s Syndrome?

<p>Central obesity (A)</p> Signup and view all the answers

What can sustained elevated blood pressure lead to?

<p>Increased risk CHD (A)</p> Signup and view all the answers

Which ocular effect can occur as a consequence of chronic hypertension?

<p>Attenuated blood vessels (D)</p> Signup and view all the answers

Gingival hyperplasia is a common oral side effect of which of the following cardiovascular drugs?

<p>Nifedipine (C)</p> Signup and view all the answers

Which sign is most frequently observed in infective endocarditis?

<p>Pyrexia (B)</p> Signup and view all the answers

Where does infective endocarditis (IE) most commonly affect in the heart?

<p>Left side (A)</p> Signup and view all the answers

Which microorganism is MOST often the cause of acute infective endocarditis?

<p><em>Staphylococcus aureus</em> (C)</p> Signup and view all the answers

If infective endocarditis becomes complicated by abscess formation, which of the following is the most appropriate treatment option?

<p>Surgery (A)</p> Signup and view all the answers

Why are blood cultures so integral in the management of IE patients??

<p>Blood cultures help identify the specific invading microorganism. (C)</p> Signup and view all the answers

What is the definitive criteria according to Duke for IE?

<p>Two major or one major and three minor (D)</p> Signup and view all the answers

Antibiotic prophylaxis is not routinely indicated for bacteraemia-producing dental procedures - what is the overriding SDCEP consensus?

<p>The clinical circumstances when antibiotic administration is warranted are extremely limited. (D)</p> Signup and view all the answers

Apart from being familiar with IE, what is the dental practitioner's MOST important and ethical responsibility?

<p>Being aware of those patients at risk and to seek advice (C)</p> Signup and view all the answers

In the context of cardiovascular health, what is the underlying cause of ankle swelling?

<p>Heart failure (C)</p> Signup and view all the answers

What is the recommended first step for a patient experiencing angina?

<p>Stop and rest (B)</p> Signup and view all the answers

Which statement best describes the underlying cause of most cases of 'essential' hypertension?

<p>Complex interaction of genetic and environmental factors (C)</p> Signup and view all the answers

What is the most common cause of secondary hypertension?

<p>Renal artery stenosis (B)</p> Signup and view all the answers

A patient presents with central obesity, hypertension, and purple striae on their abdomen. Which of the following is the most likely underlying cause?

<p>Cushing's syndrome (D)</p> Signup and view all the answers

A cardiovascular patient develops gingival hyperplasia. Which medication is most likely responsible?

<p>Nifedipine (A)</p> Signup and view all the answers

A patient with cardiovascular disease develops oral ulceration. Which of the following medications is the most likely cause?

<p>Nicorandil (D)</p> Signup and view all the answers

Which cardiovascular drug is associated with lichenoid drug reactions?

<p>Atenolol (B)</p> Signup and view all the answers

What percentage of infective endocarditis cases affect the left side of the heart?

<p>95% (D)</p> Signup and view all the answers

What is the most common causative organism in acute infective endocarditis, particularly affecting both normal and abnormal valves?

<p>Staphylococcus aureus (C)</p> Signup and view all the answers

What is the approximate mortality rate associated with right-sided infective endocarditis in intravenous drug abusers?

<p>10% (A)</p> Signup and view all the answers

According to the pie chart showing native valve bacterial endocarditis, which genus accounts for approximately 50% of cases?

<p>Staphylococci spp. (D)</p> Signup and view all the answers

In managing a patient with endocarditis complicated by vegetation formation, congestive heart failure, and neurological dysfunction, what treatment strategy is likely to be used?

<p>Prolonged antibiotic and likely surgical intervention (D)</p> Signup and view all the answers

Which of the following answers best describes the nature of Osler's nodes?

<p>Small, raised, and painful nodules on the fingers and toes (C)</p> Signup and view all the answers

What are Janeway lesions characterised by?

<p>Large, painless, hemorrhagic macules on the palms and soles (A)</p> Signup and view all the answers

According to modified Duke criteria, which findings would classify a patient as having 'definite' infective endocarditis?

<p>Two major criteria, or one major and three minor criteria (C)</p> Signup and view all the answers

What is the most important factor in determining the proper antimicrobial treatment for infective endocarditis?

<p>Identification of the causative organism (D)</p> Signup and view all the answers

According to the NICE guidelines, is antibiotic prophylaxis routinely recommended for dental procedures to prevent IE?

<p>No, it is not routinely recommended (D)</p> Signup and view all the answers

According to SDCEP guidelines, which patient group is considered at the highest risk of developing infective endocarditis (IE)?

<p>Patients with previous IE (D)</p> Signup and view all the answers

During the dental treatment of a patient at 'high risk' of infective endocarditis (IE), what is the most important area a practitioner should focus on, according to current SDCEP guidelines?

<p>Ensuring meticulous oral hygiene and minimising bacteraemia (C)</p> Signup and view all the answers

A patient with suspected infective endocarditis presents with sudden unilateral blindness. What is the likely underlying mechanism?

<p>Embolic event (B)</p> Signup and view all the answers

According to arguments 'against' prophylaxis, what presents MORE of a risk than a single dental procedure?

<p>Regular tooth brushing (B)</p> Signup and view all the answers

What is the potential negative outcome of antibiotic prophylaxis against IE?

<p>Antibiotic prophylaxis leads to net loss of life (C)</p> Signup and view all the answers

What is the most appropriate action for practitioners who are unsure about managing a patient at risk of IE?

<p>Liaise if in doubt (A)</p> Signup and view all the answers

What activity would be MORE of a risk of IE than receiving a dental procedure?

<p>Regular tooth brushing (D)</p> Signup and view all the answers

What BEST represents the most important general responsibility for dental practitioners regarding endocarditis, according to the statement, 'Endocarditis is a disease with which dental practitioners need to be familiar'?

<p>Understanding cardiovascular disorders &amp; implications for safe practice (A)</p> Signup and view all the answers

What is the main concern that is associated with hypertension?

<p>Raised blood pressure (A)</p> Signup and view all the answers

Which of the following medications, identified in cardiac disease pharmacological correction, ends in '-sartan'?

<p>Angiotensin II receptor blockers (B)</p> Signup and view all the answers

Which of the following medications, identified in cardiac disease pharmacological correction, ends in '-olol'?

<p>Beta Blockers (B)</p> Signup and view all the answers

Which blood type is associated with a slightly increased increased risk of cardiovascular disease?

<p>A, B, or AB (A)</p> Signup and view all the answers

The Rotterdam's studies showed that which are ranges had the highest prevalence of heart failure?

<p>75-84 (B)</p> Signup and view all the answers

What term is used to describe the phenomenon where a patient's blood pressure is elevated in a clinical setting, but normal in other environments?

<p>White Coat Effect (D)</p> Signup and view all the answers

In the context of infective endocarditis, what is indicated by "absent pulses" during a general examination?

<p>Embolic occlusion (C)</p> Signup and view all the answers

In the context of infective endocarditis, what does the term Vegetation refer to?

<p>A collection of microorganisms and cellular debris (D)</p> Signup and view all the answers

What is the key advice to give to patients undergoing invasive procedures such as body piercing or tattooing?

<p>Risks of undergoing invasive procedures such as body piercing or tattooing (A)</p> Signup and view all the answers

What is the significance of normal P-waves on an ECG in the context of tachycardia?

<p>It commonly refers to sinus tachycardia (A)</p> Signup and view all the answers

What is the correct ECG reading to use to determine ventricular tachycardia? (bpm = beats per minute)

<p>A rate that is usually faster than 140 bpm (D)</p> Signup and view all the answers

Which of the following would most likely suggest a cardiac issue when inspecting the signs in a clothed patient?

<p>Pallor (A)</p> Signup and view all the answers

A 68 year old patient presents with breathlessness and fatigue. They have been recorded as being a past smoker, with a BMI averaging 30. What aspect identified in 'Risk Factors' indicates that they are in the older demographic?

<p>Age (B)</p> Signup and view all the answers

In the Glasgow Coma Scale (GCS), what does 'E' stand for?

<p>Eyes response (A)</p> Signup and view all the answers

According to the content, what may be the result where there is turbulent blood flow in Heart Sounds?

<p>Murmurs (B)</p> Signup and view all the answers

In the content, what does dullness to percussion represent in Lung Sounds?

<p>Indicates pleural effusion/consolidation (D)</p> Signup and view all the answers

Which of the following symptoms is most likely associated with a cardiac arrhythmia?

<p>Palpitations (C)</p> Signup and view all the answers

Which cardiac condition is most commonly linked to atherosclerosis and thrombosis?

<p>Ischaemic heart disease (C)</p> Signup and view all the answers

Which common medication prescribed for angina is administered sublingually for rapid relief?

<p>GTN spray (A)</p> Signup and view all the answers

Which blood test is crucial for detecting myocardial damage and is indicative of acute coronary syndrome or myocardial infarction?

<p>Troponin levels (C)</p> Signup and view all the answers

Which valvular defect is characterised by the incomplete closure of the valve, resulting in backward flow of blood?

<p>Regurgitation (B)</p> Signup and view all the answers

Which heart valve is primarily affected in right-sided endocarditis among intravenous drug abusers?

<p>Tricuspid valve (A)</p> Signup and view all the answers

A patient presents with a constellation of symptoms including central obesity, striae, hypertension caused by a tumour which secretes ACTH. Which condition on the list is most likely?

<p>Cushing's syndrome (B)</p> Signup and view all the answers

According to the information provided, what activity presents a greater risk of infective endocarditis (IE) than a single dental procedure?

<p>Regular tooth brushing (A)</p> Signup and view all the answers

A patient with a known history of ventricular tachycardia is scheduled for a surgical procedure using electrocautery equipment. What should the clinical team do?

<p>Ensure the defibrillator is readily available. (D)</p> Signup and view all the answers

A cardiologist observes an irregularly irregular pulse in a patient. What arrhythmia does this suggest and why does this necessitate anticoagulation?

<p>Atrial fibrillation, to prevent arterial thromboembolism due to ineffectual atrial contractions. (B)</p> Signup and view all the answers

Flashcards

Chest Pain

Usually due to ischaemia; a common symptom of heart disease.

Breathlessness

Often indicates heart failure, but respiratory issues should also be considered.

Ankle Swelling

Can be a sign of heart failure.

Palpitations

Often signals arrhythmia.

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Feeling Faint

Low blood pressure or arrhythmia can cause this symptom.

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Pulse

Indicates rate, rhythm and volume.

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Jugular Venous Pressure (JVP)

Raised in heart failure.

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Peripheral Oedema

Indents on pressure on the skin.

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Normal Heart Sounds

Closure of mitral and aortic valves.

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Additional Heart Sounds

Murmurs due to turbulent blood flow.

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Additional Lung Sounds

Inspiratory crackles at lung bases indicate pulmonary oedema.

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Reduced Breath Sounds

Dullness to percussion indicates pleural effusion/consolidation.

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Ischaemic Heart Disease

Heart disease caused by coronary artery disease.

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Underlying Processes

Narrowing, blockage.

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Consequences

Angina or myocardial infarction (MI).

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Acute Coronary Syndrome

Unstable angina or MI.

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Management of Angina

Stop and rest, GTN spray, Anti-anginal drugs, PCI, CABG.

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ECG

Show changes during angina, MI or heart rhythm change.

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Chest X-ray

Shows enlargement and pulmonary oedema.

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Echocardiogram

Shows structure, movement of valves/heart muscle and flow across valves.

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Troponin Levels

Detects release of cardiac muscle proteins in acute coronary syndrome and MI.

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ST-elevation MI (STEMI)

Immediate coronary intervention and stent plus medical treatment.

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Non-ST-elevation (NSTEMI)

Anti-thrombotics, beta blockers, nitrates.

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Main Valvular Problems

Narrowing is stenosis. Leaking leading to regurgitation.

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Rheumatic Fever

Can happen 2-3 weeks after a streptococcal URTI.

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General Appearance

A general cardiovascular sign is breathlessness, pallor, sweating and cyanosis.

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Stress Test

A cardiac test assessing heart function under stress, using echo or perfusion scan.

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Coronary Angiogram

A detailed visualization of coronary arteries using dye and X-rays.

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Management of MI

Medical emergency, paramedics perform ECG and triage to specialist. Immediate intervention is critical.

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Heart Valves

Mitral, aortic, tricuspid and pulmonary.

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Heart Failure

Heart fails to deliver enough blood, leading to breathlessness, fatigue and oedema.

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Types of Heart Failure

Can be acute vs chronic, and right-sided vs left-sided

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Modifiable Risk Factors

Risk Factors that can be controlled, such as smoking, hyperlipidaemia, hypertension, diabetes, increased clotting and lifestyle.

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Non Modifiable Risk Factors

Risk Factors that can't be controlled, such as age, male, racial and post-menopause.

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Signs of endocarditis

Signs of endocarditis (rare but important) – splinter haemorrhages in nails, finger clubbing, fever.

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Treatments

Treat symptoms – e.g. anti-arrhythmics, diuretics for heart failure. Surgical valve repair or replacement. Minimally invasive procedures e.g. transcatheter aortic valve intervention (TAVI) for AS.

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Cor Pulmonale

Right-sided heart failure due to pulmonary hypertension in chronic lung disease.

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High Output Heart Failure

Heart failure caused by high demands on the heart, such as AV shunts or hyperthyroidism.

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Renin-Angiotensin-Aldosterone System

This system is activated in heart failure to retain salt and water, increasing blood volume.

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Sartans

These medications block Angiotensin II receptors

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Sinus Tachycardia

A rapid heart rate exceeding 100 bpm

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Atrial Fibrillation

The most common rhythm disturbance, characterized by uncoordinated atrial contraction

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Ventricular Tachycardia

A rapid heart rhythm originating in the ventricles, typically faster than 140 bpm

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Bradycardia

A slow heart rate, generally below 60 bpm

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Extrasystoles

Intermittent extra heartbeats; often felt as skipped beats

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Ventricular Fibrillation

Uncoordinated electrical activity in the ventricles leading to no cardiac output

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Asystole

Absence of electrical activity in the heart

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DC Cardioversion

Electrical shock used to restore normal heart rhythm.

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Catheter Ablation

Thin, flexible tube inserted to destroy abnormal heart tissue.

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Pacemaker

Device that delivers electrical stimulation to maintain heart rate.

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Implantable Defibrillator

Device that detects and corrects life-threatening tachyarrhythmias.

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Rate Controlling Drugs

Medications used to control the rate of atrial fibrillation

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Anticoagulation

Drugs like Warfarin and DOACs to reduce the risk of stroke in atrial fibrillation

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Commonest Causes of Heart Failure

Right-sided heart failure due to pulmonary hypertension in chronic lung disease.

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Aldosterone Antagonists

Blocks aldosterone, reducing sodium and water retention, thus lowering blood pressure and reducing fluid overload in heart failure.

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Vasodilators

Medications that widen blood vessels, reducing blood pressure and easing the workload on the heart

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Loop Diuretics

Medications that increase urine production, helping to remove excess fluid from the body and relieve symptoms

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Hypertension

Elevated blood pressure, a significant risk factor for heart failure and other cardiovascular diseases.

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Valvular Heart Disease

Heart disease involving one or more of the heart valves, leading to impaired blood flow.

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Breathlessness in Heart Failure

Shortness of breath, a common symptom of heart failure due to fluid accumulation in the lungs.

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Fluid Retention in Heart Failure

Excess fluid accumulation in the body, leading to swelling, often in the ankles, due to heart failure.

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Fatigue in Heart Failure

A feeling of tiredness or lack of energy, often resulting from poor cardiac output in heart failure.

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CXR in Heart Investigations

Chest X-Ray; helps visualize heart size and detect pulmonary edema.

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ECG in Heart Investigations

Electrocardiogram; records heart's electrical activity to identify arrhythmias or ischemia.

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U&E

Measures electrolytes and kidney function.

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FBC

Full blood count; assesses overall health and detects anemia.

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Thyroid Function Tests

Used to rule out hyperthyroidism.

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Compensatory Mechanisms

Body's attempt to maintain circulation but causes fluid overload.

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ACE Inhibitors

ACE Inhibitors, end in '-pril'

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Beta Blockers

Beta Blockers, usually end in '-olol'

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Sino-atrial node

Electrical nodes that control impulses in the heart

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Atrio-ventricular Node

Coordinates electrical activity between atria and ventricles.

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His-Purkinje System

Ventricular conducting tissue – His-Purkinje system

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Warfarin management

Maintaining INR <4 with Warfarin.

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DOACs

Drugs including dabigatran, rivaroxaban, and apixaban; SDCEP guidelines

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Hypertension: BP Level

The level above 140/90 mmHg

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Measuring Blood Pressure

Using a recommended device, average of two sitting measurements preferred.

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'Essential' Hypertension

Most cases (90%) with poly-causal, genetic, and environmental factors.

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Secondary Hypertension

Uncommon (10%), findable if BP is poorly managed, patient is young

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Secondary Hypertension Causes

Renal artery stenosis, Conn's, Cushing's syndrome

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Cushing's Syndrome

Tumor makes extra ACTH and steroids

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Elevated BP Effects

Increases heart disease, aortic aneurysm, stroke risk

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Hypertensive Encephalopathy

Severe hypertension leading to coma and seizures

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Hypertension: Effects on Eyes

Blood vessels narrow/bleed, possibly causing sight loss

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Nicorandil Side Effect

Causes oral ulceration (K+ Channel Activator)

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Atenolol Side Effect

Causes lichenoid drug reactions (Beta Blocker)

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Nifedipine/Amlodipine Side Effect

Causes gingival hyperplasia (Ca Channel Blocker)

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Infective Endocarditis (IE)

Infection of the heart's inner lining or valves.

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IE: Affected Heart Side

Most cases affect the left heart: mitral/aortic valves.

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Acute IE cause

Often caused by the bacteria Staphylococcus aureus affecting normal and abnormal valves

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IE: Risk Factors

IV drug use, prosthetic valves, catheterization.

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Native Valve IE microbes

Native valve IE is most commonly caused by Streptococci Staphlococci

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IE 'Toxic Features'

Fever, sweats, malaise, weight loss are symptoms of what?

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Warfarin rule in anticoagulation

Check INR is less than 4 and use local haemostatic measures for patients

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Phaeochromocytoma

Rare condition with postural hypotension, headaches due to catecholamine-producing growth.

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Elevated BP effects on the heart

Damage to the heart, increases risk of CHD, LVH and arrhythmias.

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Glomerulonephritis

Inflammation of glomeruli, filters in kidneys damage

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Tricuspid valve related to IV drug abuse

Right-sided endocarditis, usually presents acutely in IV drug abusers or the immunosuppressed and affects this valve.

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IE Mortality Rate

Average mortality rate of infective endocarditis

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Fungal endocarditis prognosis

More than 50% mortality rate.

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Bacterial endocarditis

The heart's valves are infected with bacteria.

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Prosthetic Heart Valves

Infective Endocarditis that presents early (within 60 days) or late.

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Hypertension Level

Previously above 140/90, treatment is based on cardiovascular risk level.

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Ambulatory BP monitoring

Monitor variability between home and clinic and consider 'white coat effect'.

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Most common cause of bacterial endocarditis

Oral streptococci bacteria

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Renal artery stenosis

Kidney issue that is common in older patients with vascular disease.

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Arrhythmias (Cardiac Feature)

Cardiac arrhythmias are irregular heartbeats. They are a cardiac feature of infective endocarditis.

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Deteriorating Valve Function

This is a cardiac feature associated with IE, where the ability of the heart valves to function correctly deteriorates, affecting blood flow.

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Changing Murmurs

Changing heart murmurs, detected during auscultation, can an IE cardiac feature of infective endocarditis, indicating altered blood flow patterns.

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Heart Failure (Cardiac)

Heart failure is a cardiac manifestation of infective endocarditis, where the heart cannot pump enough blood to meet the body's needs.

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Limb Septic Emboli

Septic emboli in limbs, detectable via the iliac artery (Panel A), are caused by infected clots that have traveled through the bloodstream.

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Cerebral Septic Emboli

Septic emboli in the brain, as seen in Panel B, are infected clots that travel to the brain, potentially causing stroke or abscess.

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Cardiac Septic Emboli

Septic emboli affecting cardiac vessels, such as the left anterior descending artery are caused by infected clots blocking vessel blood flow in the heart (Panel B).

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Glomerulonephritis Symptoms

Glomerulonephritis resulting from immune complexes is associated with loin pain and haematuria

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Osler's Nodes

Osler's nodes are red-purple, raised, tender lumps typically found on the fingers or toes. They are painful and can last from hours to several days.

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Splinter Hemorrhages

Splinter hemorrhages are tiny blood clots that occur under the fingernails.

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Janeway Lesions

Janeway lesions are small, painless, red or purple macules or nodules on the palms or soles.

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Diagnosis of IE

Clinical features, blood cultures, and imaging are used to diagnose IE.

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IE Treatment

Treatment for IE involves antimicrobial treatment and sometimes surgery along with managing and preventing complications.

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Antimicrobial Treatment

The choice and length of antimicrobial treatment for IE is determined by the pathogen isolated from culture.

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Antibiotic Prophylaxis

Antibiotic prophylaxis against IE is not routinely recommended

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IE General examination

General appearance, pyrexia, tachycardia, embolic events and eye changes are signs that might be elicited on general examination.

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Major Criteria

According to the Duke criteria for IE, blood cultures must be positive for IE, typical microorganisms consistency with IE and Evidence of endocardial involvment

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Minor criteria

According to the Duke criteria for IE, a predisposition, fever vascular and immunological phenomena or microbiological evidence are considered minor criteria

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IE Definite Diagnosis

IE definite if two major criteria, or one major and three minor criteria, or five minor criteria are present.

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IE Possible Diagnosis

IE possible if one major and one minor criteria, or three minor criteria are present.

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Rationale for Antibiotic Prophylaxis

Bacteraemia, cases of IE following dental procedures and IE being caused by oral organisms supports the use of antibiotic prophyaxis after a dental procedure.

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Increased IE Risk

Patients with previous IE, prosthetic valve and cyanotic congenital heart disease should get antibiotic premedication when undergoing a dental procedure

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Scope of NICE Guideline

The NICE guidelines aim to guide healtcare professionals in the appropriate care of people considered to be at increased risk of IE

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IE Moderate Risk

Those patients with previous rheumatic fever, valvular heart disease and unrepaired congenital anomalies of the heart valves are at a moderate risk of IE with the SDCEP

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SDCEP Guidelines Topic

Importance of good OH and what signs to look out for can be found on SDCEP guildelines

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IE Cardiac Features?

Arrhythmias, deteriorating valve function, changing murmurs and heart failure.

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Septic Emboli Destinations?

Infective Emboli that travel to the limbs (iliac artery), brain and heart.

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Immune Complexes in IE?

Can lead to loin pain and haematuria.

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IE Diagnosis Components?

Clinical features blood cultures and imaging

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General Examination Findings of IE?

Earthy look, pallor, toxic face, pyrexia, tachycardia, skin lesions, absent pulses, eye issues

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Blood Cultures in IE?

Can be negative in 14% of IE cases.

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Definite IE Diagnosis?

Diagnosis is definite if two major criteria, or one major and three minor criteria, or five minor criteria are met.

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IE Antibiotic Prophylaxis?

Antibiotic prophylaxis against IE is not routinely recommended.

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Increased Risk of IE?

IE: Previous IE, prosthetic valve, cyanotic congenital heart disease, congenital heart disease repaired with prosthetic material

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Moderate Risk of IE?

Previous history of rheumatic fever, patients with valvular heart disease, patients with unrepaired congenital anomalies of the heart valves

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IE and Interventions

There is no consistent evidence linking interventional procedures to the development of infective endocarditis (IE).

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Tooth brushing vs Dental Work

Routine tooth brushing may pose a higher risk of infective endocarditis than a single dental procedure.

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Antibiotic Prophylaxis Effectiveness

Antibiotic prophylaxis has not been proven clinically effective against infective endocarditis.

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Cost-Effectiveness of Antibiotic Prophylaxis

Antibiotic prophylaxis against infective endocarditis for dental procedures may not be cost-effective and could lead to a net loss of life.

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Patient education

Providing guidance on benefits, risks, oral hygiene, relevant symptoms, and dangers of invasive procedures.

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Importance of Cardiovascular Knowledge

A foundational understanding of cardiovascular disorders and their potential implications is essential for ensuring safe and effective clinical practice.

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Dental Practitioners and Endocarditis

Dental practitioners should be well-versed in endocarditis.

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Antibiotic Use Post-Dental Work

Currently, antibiotic prophylaxis is not routinely indicated for bacteremia- producing dental procedures, though the debate has nuances; consult specialists if unsure.

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Patient Prevention Advice

Healthcare professionals should give clear and consistent advice about prevention techniques.

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Endocarditis Awareness

Dental practitioners need to be familiar with endocarditis.

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Daily oral hygiene vs IE risk

Regular tooth brushing presents a greater risk of IE than a single dental procedure.

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Chest Pain - Ischaemia

Chest pain due to reduced blood flow to the heart muscle.

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Orthopnea

Difficulty breathing especially when lying down, often caused by fluid in lungs (pulmonary edema).

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Pitting Oedema Mechanism

Raised hydrostatic pressure, forcing fluid into interstitial space.

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What is acute coronary syndrome?

Classified as unstable angina or myocardial infarction.

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Nicorandil

A drug used to treat angina, that activates potassium channels

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Echocardiogram (Doppler)

An diagnostic cardiac test using ultrasound with doppler to measure the heart structures

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What is IE?

Infective endocarditis.

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Acute IE causative organism

Staphylococcus aureus.

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Infective Endocarditis: High Risk Factors

Previous IE, prosthetic valves, cyanotic congenital heart disease and congenital heart disease requiring prosthetic material for 6 months minimum or residual issues.

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Infective Endocarditis: Moderate Risk Factors

Previous history of rheumatic fever, valvular heart disease and unrepaired congenital heart defects.

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IE: Diagnosis factors

Clinical features and blood cultures.

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IE: General Examinations (Eyes)

Sub-conjunctival haemorrhages.

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IE: Minor Criteria - Immunologic Phenomenon

Osler's nodes.

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IE: Antibiotic Treatment

Choice and length of antimicrobial treatment dependent on pathogen identified in culture.

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What is the result of having prosthetic heart valves?

Increased risk.

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Infective Endocarditis: Risk of Intervention and Development Result

No evidence that tooth brushing is responsible.

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IE: Patient Advice Aspects

Benefits and risks, importance of oral health, signs of IE, and risks of invasive procedures.

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How do you shorten an angina attack?

A quick acting medication (e.g GTN spray) is used

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What is pulmonary oedema?

This can be indicated by inspiratory crackles at lung bases.

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Atherosclerosis and thrombosis

These are narrowed or blocked coronary arteries.

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NSTEMI

Medical managment to include anti-thrombotics, beta blockers and nitrates.

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What is the Mitral valve?

Narrowing of this heart valve can cause stenosis.

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Arrhythmias Lead To...?

Arrhythmias impair effective heart pumping.

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Non Cardiac Causes To Heart Failure?

Arterio-venous shunts, anaemia and hyperthyroidism can all overload the heart.

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Pharmaceutical for Heart Failure?

ACE Inhibitors (pril), Angiotensin II receptor blockers (sartan).

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Paroxysmal Nocturnal Dyspnea (PND)

Refers to breathlessness that awakens the patient from sleep, prompting them to sit up.

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Modifiable Risk Management

Lifestyle changes like diet and exercise.

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ECG usage

Show changes during angina or MI, and heart rhythm.

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Tissue Valve

A valve made from animal tissue, which have a limited lifespan.

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Acute Heart Failure

Acute is pulmonary oedema with breathlessness at rest.

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Combined Heart Failure

Often both together (congestive). Right sided causes peripheral oedema and raised JVP.

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Arrhythmia Therapy

Treats arrhythmia-related symptoms, such as anti-arrhythmics/diuretics for heart failure.

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Electrical Activity Present?

Cardiac arrest but not 'shockable'.

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Most Common Rhythm Disturbance

The most common rhythm disturbance.

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Anti-Arrhythmia

Anti-arrhythmic drugs – beta blockers, amiodarone.

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Arteriosclerosis

Narrowed blood vessels, which can be caused by thickening of arterial walls.

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Mechanical Valve

A mechanical valve is more durable but needs anticoagulation.

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Hypertension ? Causes

Rare(10%) of cases, search if BP very high/poorly controlled/indicators/young.

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Blood Cultures

Blood cultures are negative in 14% of cases of IE.

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Right sided

Right sided endocarditis in intravenous drug abuse: specific forms.5% of cases • tricuspid valve,.usually presents acutely in I.V. drug abusers or the immunosuppressed.

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Specific forms

IV drug abuse: Specific forms damanged heart valves

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Types ?

Prosthetic heart valves:

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Study Notes

  • Signs/Symptoms of Heart Disease

Overview of Heart Disease Signs and Symptoms

  • Chest pain is typically due to ischaemia.
  • Breathlessness is often associated with heart failure, keep respiratory issues in mind.
  • Ankle swelling is an indicator of heart failure.
  • Palpitations suggest arrhythmia.
  • Feeling faint may be due to low blood pressure or arrhythmia.

Identifying Signs in a Clothed Patient

  • General appearance can reveal breathlessness, pallor, sweating, or cyanosis (central, peripheral).
  • Assess pulse for rate, rhythm, and volume.
  • Check blood pressure.
  • Jugular Venous Pressure (JVP) may be raised in heart failure.
  • Peripheral oedema, identified by 'pitting' upon pressure, may be present.

Other Signs of Heart Disease

  • Heart sounds should be normal, indicating the closure of the mitral and aortic valves.

  • Additional heart sounds, such as murmurs, are due to turbulent blood flow.

  • Lung sounds should be normal vesicular breath sounds.

  • Additional lung sounds like inspiratory crackles at lung bases indicate pulmonary oedema.

  • Reduced breath sounds and dullness to percussion suggest pleural effusion or consolidation.

  • Ischaemic Heart Disease

Ischaemic Heart Disease Explained

  • Coronary artery disease is the primary cause.
  • Atherosclerosis (narrowing) and thrombosis (blockage) are underlying pathological processes.
  • Consequences include angina (narrowing) and myocardial infarction [MI] (blockage).
  • Acute Coronary Syndrome encompasses unstable angina and MI.

Management of Angina

  • Management involves stopping activity and resting.
  • GTN spray administered sublingually shortens attacks.
  • Regular anti-anginal drugs include beta blockers like bisoprolol, nitrates like isosorbide mononitrate, and calcium channel blockers like amlodipine.
  • Nicorandil, a potassium channel activator, is another treatment option.
  • Percutaneous coronary intervention (PCI) and Coronary artery bypass graft (CABG) are also used.

Risk Factors

  • Modifiable Risk Factors -These include smoking, alcohol consumption, Hyperlipidaemia and Hypertension

  • Also diabetes/overweight, increased clotting, and poor lifestyle choices such as poor diet or lack of exercise.

  • Non-Modifiable

  • These include age, male gender, racial group, and being a post-menopausal woman.

Cardiac Investigations

  • ECGs detect changes during angina or MI, and heart rhythm abnormalities.
  • Chest X-rays reveal heart enlargement and pulmonary oedema.
  • Echocardiograms (ultrasound with doppler flow study) show structure, movement of valves and heart muscle, and blood flow.
  • Stress tests, such as stress echo or myocardial perfusion scan, identify reversible ischaemia.
  • Cardiac MRI and Coronary angiograms (invasive, guides intervention such as stent placement).
  • Troponin levels, measured via blood test, indicate release of cardiac muscle proteins in acute coronary syndrome - and indicate MI.

Management of MI

  • It is a medical emergency, paramedics perform ECG and triage to a specialist centre.
  • Inform if given aspirin 300mg (chewed).
  • In ST-elevation MI (STEMI), immediate coronary intervention and stent placement plus medical treatment is needed.
  • non-ST-elevation MI (NSTEMI) is approached through anti-thrombotics, beta blockers, and nitrates.

Valvular Heart Disease

  • Valves are mitral, aortic, tricuspid, and pulmonary. The main problems are narrowing (stenosis), leaking, potentially leading to regurgitation

Rheumatic Fever

  • Can occur 2-3 weeks after a streptococcal URTI.
  • It impacts the heart, causing Rheumatic Heart Disease, Endocarditis, Myocarditis (Aschoff bodies) and Pericarditis
  • Can cause Arteritis in the arteries, 'Flitting' polyarthritis in the joints, and Skin rashes and Subcutaneous nodules in the skin

Treatments for Heart Disease

  • This involves treating symptoms with anti-arrhythmics and diuretics for heart failure.
  • Surgical valve options are repair or replacement, with tissue valves having limited lifespans and mechanical valves requiring anticoagulation.
  • Minimally invasive procedures can be used eg transcatheter aortic valve intervention (TAVI) for AS

Heart Failure

  • Heart Failure Definition
  • Heart has failed to deliver enough blood for the needs of the body.
  • It's clinical syndrome with multiple causes, including breathlessness, fatigue and oedema.
  • Types of Heart Failure
  • Can Acute or Chronic. Acute can lead to pulmonary oedema.
  • Can be right-sided or left-sided, often both are congested.

Causes of Heart Failure

  • Common Causes Ischaemic heart disease and Hypertension. Valvular heart disease
  • Chronic Obstructive Pulmonary Disease
  • cor pulmonale, can cause right sided heart failure.
  • Non-Cardiac Causes
    • Excessive demand in high output heart failure due to Arterio-venous shunts / Anaemia or Hyperthyroidism Fluid overload from other causes: IV therapy or Renal injury (failure)
  • Symptoms
    • Breathlessness, Fluid Retention or Fatigue
  • Investigations
    • Requires a CXR or ECG
  • Management Mechanisms
    • Reduced cardiac output and blood pressure resembles dehydration or haemorrhage.
    • Activate the renin-angiotensin-aldosterone system to retain salt and water
    • Activate sympathetic nervous system to vasoconstrict and stimulate heart
  • Treatments
    • ACE inhibitors --opril
    • Angiotensin II receptor blockers ---sartan
    • Aldosterone antagonists e.g. spironolactone
    • Loop diuretics to treat symptoms due to fluid overload
    • Beta blockers ----olol
    • Vasodilators – hydralazine, nitrates

Cardiac Rhythm Disturbances

  • Normal Cardiac Electrical system
    • Sino-atrial node
    • Atrial Tissue
    • Atrio-ventricular node
    • Ventricular conducting tissue - His-Purkinje system
  • ECG - electrocardiogram (image in text)

Rhythm Disturbances

  • Tachycardias, Sinus Tachycardia
    • Sinus Tachycardia is > 100 bpm, this is a normal response to exercise or emotion. . Hyperthyroidism, hypovolaemia, fever, heart failure can lead to this. Normal p-waves on ECG occur
  • Atrial Fibrillation
    • The most common rhythm disturbance
    • Leads to being anticoagulated
    • Results in a rapid rate, irregular ventricular rate and can cause an irregular pulse.
  • Ventricular Tachycardia
    • Rate usually faster than 140 bpm, often associated with ischaemic heart disease and can be caused by drugs
  • Bradycardias are < 60 bpm
    • Sinus bradycardia maybe be normal in athletes.
    • With beta blockers may cause blackouts or dizzy spells
  • Extrasystoles - a most common type
    • Disturbance requires a sensation of missed or extra beats but usually has no clinical significance
  • Ventricular Fibrillation
    • Requires an AED to reverse. There is no cardiac output so cardiac arrest occurs and it causes death.
  • Asystole - not 'shockable'
    • There is an absence of electrical activity and contraction. Causes sudden cardiac arrest and death.
  • Treatments for Arrhythmias
    • Anti-arrhythmic drugs – beta blockers, amiodarone
    • DC cardioversion
    • Cardiac arrest
    • Catheter ablation
    • Pacemakers for bradycardia
    • Implantable defibrillators for VT or VF, must always check for electrical interference from electro-cautery equipment.
  • Rate-controlling drugs – beta blockers/digoxin and/or Anticoagulation - warfarin or DOAC.

Blood Pressure and Hypertension

Hypertensions BP levels

  • Above 140/90 is previously standard
  • Now tend to treat according to level of BP and overall cardiovascular risk
  • Measuring Blood pressure - . Use a recommended device while seated and take at least 2 measurements and average 2 readings. Variability causes "white coat effect"
  • Hypertension Aetiology
    • 'Essential' Hypertension: 90% cases.
    • Causes: environmental, obesity, salt intake, lack of excersise and mutliple genetic influences
  • Hypertension - Secondary. 10% are relatively rare cases
    • if BP very high, Renal function problems or patient symptoms could causes a clue
  • Secondary Hypertension -
    • Common causes are renal
    • renal artery stenosis and older patient with vascular disease
    • Endocrine causes: Conn's syndrome or Cushing's syndrome
    • Intrinsic renal disease e.g. glomerulonephritis
  • Centrally obese patient with Cuhsing's syndrome or adrenal adenoma has ? Electrolytes show low K What Effects can Elevated BP Have? Increases risk of CHD with peripherial disease
    • Aneurysm. Cerebral circulation causing stroke Oral Issues -
  • Bendroflumethiazide causes - Atenolol, Lichenoid and oral ulcerations Infective Endocarditis Information
  • IE affects the left aide with Bacterial growth
  • Acute cases are caused by Staphylococcus aureus
  • Prosthetic Heart Valves can present early, or late
  • Endocarditis in intravenous drug abuse is usually presents acutely

Risk Factors

  • These include drug abuse, Abortion, Prosthetic valve and Cardiac and urinary catheterisation
  • Procedures Include -Dental and urological
  • Incidences around for Cardiac Deaths
  • Is between 1.7-6.2 cases Europe / USA, increasing in UK. Mortality rate is higher over 65s
  • Infections are common Native Valvue
  • Caused by Oral streptococci
  • Diagnosis through Features/Blood work

IE 'Toxic' Features

  • These include Pyrexia, Sweats or Splenomegaly
  • Leads to arrythmias with heart failure
  • can be emolic to Limbs, Cardiac functions
  • Glumerulonephritis occurs causing loin pain and haematuria
  • Fingers / Toes - Osler's nodes can be tender and painful for hours
  • A diagnosis is defined through criteria, which can show Antibodies to streptococcal polysaccharide and raised Antistreptolylin O titres (ASOT)
  • Signs can include splinter haemorrhages in nails, finger clubbing, fever

Treatment

  • Must use a suitable treatment dictated by from culture
  • Antibiotic Prophylaxis for Dentists. Recent update with high / medium risk Increases risk of IE with SDCEP Previous IE
  • Any form of prosthetic heart valve and cyanotic diseases
  • SDCEP. www.sdcep.org.uk
  • Has a template letter for cardiologists.

Arguments Against Prophylaxis

Reasons Against Prophylaxis

  • There is no consistent association between an interventional procedure and the development of IE
  • Regular tooth brushing presents a greater risk of IE than a single dental procedure
  • Antibiotic prophylaxis clinical effectiveness is unproven.
  • Antibiotic prophylaxis against IE for dental procedures is not cost effective and may lead to a net loss of life

Patient Advice

  • Healthcare professionals should offer clear and consistent advice about prevention which includes the Benefits and risks, the importance of maintaining good oral health, the symptoms that may indicate IE and when to seek advice, and the risks of undergoing invasive procedures such as body piercing or tattooing

Summary

  • A working knowledge of cardiovascular disorders and their implications/potential implications is important for safe clinical practice
  • Endocarditis is a disease with which dental practitioners need to be familiar
  • Antibiotic prophylaxis isn't routinely indicated for bacteremia producing dental procededs.
  • there are subtleties to the debate, so liase if in doubt also.

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