Podcast
Questions and Answers
A patient presents with a painful and swollen calf after a period of post-operative bed rest. Which of the following mechanisms is the MOST likely cause of this condition?
A patient presents with a painful and swollen calf after a period of post-operative bed rest. Which of the following mechanisms is the MOST likely cause of this condition?
- Sudden rupture of a Baker's cyst causing fluid buildup in the calf.
- Increased production of clotting factors due to surgery-related stress.
- Accumulation of blood in the valves of the calf muscles due to inactivity (correct)
- Bacterial infection in the calf muscles leading to inflammation and swelling
Which of the following scenarios BEST illustrates the concept of Virchow's triad in the context of thrombosis?
Which of the following scenarios BEST illustrates the concept of Virchow's triad in the context of thrombosis?
- A patient with a genetic predisposition to hemophilia experiences excessive bleeding after a minor injury.
- A patient with atherosclerosis develops a thrombus due to changes in the vessel surface, blood flow, and blood composition. (correct)
- A patient with a vitamin K deficiency develops impaired clotting function and prolonged bleeding times.
- A patient who accidentally overdoses on warfarin experiences severe internal bleeding.
A patient is diagnosed with deep vein thrombosis (DVT). Which of the following statements BEST describes the potential consequences of this condition?
A patient is diagnosed with deep vein thrombosis (DVT). Which of the following statements BEST describes the potential consequences of this condition?
- DVT leads to an increased risk of arterial blockage in the brain, causing stroke.
- DVT can cause thrombus formation in the lower limb deep veins, obstructing flow and potentially releasing fragments into systemic circulation. (correct)
- DVT primarily affects the superficial veins of the legs, causing cosmetic issues but posing no significant health risks.
- DVT results in the formation of plaques in the coronary arteries, increasing the risk of myocardial infarction.
How would you differentiate thrombosis from normal clotting?
How would you differentiate thrombosis from normal clotting?
A patient is experiencing central, strangling chest pain radiating to the left arm, accompanied by nausea and sweating. An ECG shows ST elevation. Initial treatment should include which combination of the following?
A patient is experiencing central, strangling chest pain radiating to the left arm, accompanied by nausea and sweating. An ECG shows ST elevation. Initial treatment should include which combination of the following?
A patient with peripheral vascular disease experiences central chest pain during a dental procedure. After administering oxygen and GTN spray twice with a 10-minute interval, there is no improvement. What is the MOST appropriate next step?
A patient with peripheral vascular disease experiences central chest pain during a dental procedure. After administering oxygen and GTN spray twice with a 10-minute interval, there is no improvement. What is the MOST appropriate next step?
Which of the following sets of symptoms BEST describes the progression from angina to a potential myocardial infarction (MI)?
Which of the following sets of symptoms BEST describes the progression from angina to a potential myocardial infarction (MI)?
Which of the following is the MOST LIKELY underlying cause of ischemic heart disease (IHD)?
Which of the following is the MOST LIKELY underlying cause of ischemic heart disease (IHD)?
A patient experiencing angina pectoris describes the pain as a 'strangling feeling' in the chest, accompanied by breathlessness. Where else is the patient MOST LIKELY to experience referred pain?
A patient experiencing angina pectoris describes the pain as a 'strangling feeling' in the chest, accompanied by breathlessness. Where else is the patient MOST LIKELY to experience referred pain?
Which ECG finding is MOST indicative of an angina attack?
Which ECG finding is MOST indicative of an angina attack?
A patient with ischemic heart disease (IHD) is taking multiple medications. Which medication is MOST LIKELY to cause a bleeding tendency during dental procedures?
A patient with ischemic heart disease (IHD) is taking multiple medications. Which medication is MOST LIKELY to cause a bleeding tendency during dental procedures?
Which of the following is the MOST significant factor determining the likelihood of tissue damage following arterial occlusion?
Which of the following is the MOST significant factor determining the likelihood of tissue damage following arterial occlusion?
A patient presents with a history of hypertension, diabetes, and smoking. To BEST reduce their risk of ischemic heart disease (IHD), which lifestyle modification should be PRIORITIZED?
A patient presents with a history of hypertension, diabetes, and smoking. To BEST reduce their risk of ischemic heart disease (IHD), which lifestyle modification should be PRIORITIZED?
Flashcards
Ca channel blockers side effect?
Ca channel blockers side effect?
Certain calcium channel blockers can cause an overgrowth of the gingival tissue.
MI symptoms (patient reported)?
MI symptoms (patient reported)?
Central chest pain > 15 mins, radiating pain, nausea/vomiting.
MI signs (observed)?
MI signs (observed)?
Grey tinge, sweating, and tachycardia (fast heart rate).
Clotting vs. Thrombosis?
Clotting vs. Thrombosis?
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Virchow's Triad?
Virchow's Triad?
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Managing Chest Pain in Dental Setting
Managing Chest Pain in Dental Setting
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Clinical Symptoms of Ischemia (3)
Clinical Symptoms of Ischemia (3)
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Clinical Symptoms of Infarction (3)
Clinical Symptoms of Infarction (3)
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Factors Influencing Ischemia/Infarction (4)
Factors Influencing Ischemia/Infarction (4)
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Ischemic Heart Disease (IHD) Cause
Ischemic Heart Disease (IHD) Cause
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IHD Progression
IHD Progression
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Modifiable Risk Factors for IHD (9)
Modifiable Risk Factors for IHD (9)
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Angina Pectoris
Angina Pectoris
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Study Notes
- Study notes on managing chest pain, ischemia, infarction, IHD, angina, myocardial infarction, clotting, thrombosis and deep vein thrombosis
Management of Central Chest Pain in Patients with Peripheral Vascular Disease During Dental Treatment
- Follow DRS ABC (Danger, Response, Send for help, Airway, Breathing, Compressions)
- Administer Glyceryl Trinitrate (GTN) spray
- Give 15L/min oxygen
- Repeat GTN after 10 minutes
- If no response, call emergency services, suspecting myocardial infarction (MI)
- Administer 300mg chewed aspirin
- Radiating pain and shortness of breath indicate angina due to arterial stenosis from atherosclerosis
- Radiating pain + shortness of breath + sweats + pallor + anxiety indicate MI
- For MI, administer 300mg chewed aspirin and call emergency services
- Consider relative analgesics like 50% oxygen and 50% nitrous oxide
Clinical Symptoms of Ischemia
- Angina
- Transient Ischemic Attack (TIA)
- Peripheral vascular disease presenting as intermittent claudication (calf muscle pain)
Clinical Symptoms of Infarction
- Myocardial infarction
- Stroke
- Gangrene (localized death and decomposition of body tissue)
Factors Influencing Ischemia/Infarction
- Collateral blood supply
- Speed of arterial occlusion
- Metabolic needs of tissue
- Degree of arterial blocking
Ischemic Heart Disease (IHD)
- Caused by atheromatous plaque within coronary arteries constricting blood flow
- Leads to inadequate oxygen supply to meet the heart's demands
Progression of IHD
- Plaque rupture can lead to acute thrombus and myocardial infarction
Modifiable Risk Factors for IHD
- Hyperlipidaemia
- Smoking
- Hypertension
- Diabetes
- Obesity
- Lack of exercise
- High alcohol intake
- Stress
- Oral contraceptive pill (OCP)
Angina Pectoris
- Reduced oxygen perfusion of the cardiac muscle
- Symptoms include a strangling feeling in the chest, breathlessness, and pain radiating to the jaw and left arm
- ECG shows ST depression
- Pain resolves in minutes following rest and GTN
Oral Cavity Effects of Angina/Myocardial Infarction Treatment (Polypharmacy)
- Aspirin leads to bleeding tendency
- Beta Blockers can cause lichenoid reactions
- Calcium channel blockers can cause gingival overgrowth
- Nicorandil can cause oral ulceration
Symptoms of Myocardial Infarction
- Central strangling pain lasting longer than 15 minutes
- Pain radiates to the neck, jaw, and left arm
- Nausea and vomiting
Signs of Myocardial Infarction
- Grey tinge
- Sweating
- Tachycardia
ECG and Treatment for Myocardial Infarction
- ECG shows ST elevation
- Treatment involves oxygen, GTN, aspirin, and Entonox
Clotting vs. Thrombosis
- Thrombosis involves both platelets and the clotting cascade, while clotting mainly involves the cascade
- Thrombosis is haemostasis occurring in the wrong place and at the wrong time
- Thrombosis is harmful, while clotting leads to fibrin formation for healing
Deep Vein Thrombosis (DVT)
- Prolonged inactivity can lead to blood accumulating in valves, especially in calf muscles, leading to DVT then embolus
Virchow's Triad (Factors Promoting Thrombosis)
- Changes in the surface of the vessel
- Changes in blood flow
- Changes in the constituents of the blood
Vessel Surface Changes and Thrombosis
- Atheromatous plaque causes loss of the endothelial layer
- This leads to exposure of sub-endothelial tissues, triggering platelet and clotting cascade activation
Altered Blood Flow and Thrombosis
- Inactivity leads to blood accumulation in valves, especially calf muscles, causing DVT and embolus
Characteristics of Deep Vein Thrombosis
- Thrombus formation in lower limb deep veins
- Thrombus enlarges and obstructs flow
- May release fragments into systemic circulation
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Description
Study notes on managing chest pain, ischemia, infarction, IHD, angina, myocardial infarction, clotting, thrombosis and deep vein thrombosis. Includes when to administer Glyceryl Trinitrate (GTN) spray or call emergency services.
