Cardiovascular disease DTH22 - Tagged.pdf

Cardiovascular disease Module: Biomedical Sciences Tutor: Haydee Husain BDS MSc GDC Learning Outcomes 1.1.3 Explain general and systemic disease and their relevance to oral health 1.15 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their applicati...

Cardiovascular disease Module: Biomedical Sciences Tutor: Haydee Husain BDS MSc GDC Learning Outcomes 1.1.3 Explain general and systemic disease and their relevance to oral health 1.15 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their application to patient management 1.16 Describe relevant and appropriate physiology and explain its application to patient management 1.8.5 Recognise ad manage medical emergencies 1.10.6 Describe the health risks of diet, drugs and substance misuse, and substances such as tobacco and alcohol on oral and general health and provide appropriate advice, referral and support Intended learning outcomes At the end of the session students will be able to: Understand the different types of cardiovascular disease, their aetiology and management Describe the implications of these heart conditions and be aware of how this may affect patient management Related topics: Heart and circulatory system Rheumatic fever and endocarditis Congenital heart disease (Year 2 Dental Specialties) What is cardiovascular disease? Cardiovascular disease (CVD) refers to a group of disorders of the heart and blood vessels UK Statistics: 7.6million people living with cardiovascular disease 450 deaths every day 100 000 hospital admissions every year due to heart attacks 1 stroke every 5minutes Total annual healthcare cost of £9billion (British Heart Foundation) Types of cardiovascular disease Coronary heart disease Cerebrovascular disease Peripheral vascular disease Deep vein thrombosis and pulmonary embolism Valvular heart disease Congenital heart disease Question What lifestyle risk factors for cardiovascular disease can you think of? Can you think of any others risk factors? Risk factors for cardiovascular disease – lifestyle factors Unhealthy diet (particularly diets high in salt) Physical inactivity Obesity Smoking Alcohol Risk factors for cardiovascular disease – other factors Hypertension High cholesterol Diabetes Kidney disease Age Gender Ethnicity Family history Atherosclerosis Atherosclerosis is the common disorder that underlies CVD Narrowing of arteries due to build up of plaques (atheroma) Limits the flow of oxygen rich blood to organs The endothelium of the artery sustains subtle chemical or physical damage triggering a chronic inflammatory response Atherosclerosis - stages Endothelial injury or dysfunction Fatty streak - Lipids accumulate beneath the damaged endothelium Inflammatory response – Recruitment of white blood cells and foam cell formation Plaque progression – migration of smooth muscle cells, increased connective tissue, calcification, platelet adhesion and fibrous cap formation Plaque disruption Atherosclerosis – Risk factors Physical stress on arteries Turbulent flow for example where arteries branch Smoking/air pollution - circulation of reactive oxygen radicals Dyslipidaemia - High total cholesterol, high LDLs, low HDLs Chronically elevated blood glucose levels Atherosclerosis - Complications Thrombosis - May block (occlude) the artery completely Infarction - Impaired blood flow leads to tissue death Embolus which can travel in the bloodstream to a coronary artery or artery supplying the brain Ischaemic heart disease, Angina, Myocardial infarction (heart attack), Cerebrovascular disease (stroke), Aneurysm, Peripheral vascular disease Break Ischaemic Heart Disease Ischaemia = a restriction of blood supply to tissues Ischaemic (coronary) heart disease due to atherosclerosis and hypertension Leads to angina pectoris and myocardial infarction Infarction can lead to acute failure of the entire circulation, loss of cerebral blood supply and death Risk factors: age, smoking, hyperlipidaemia, diabetes, hypertension Hyperlipidaemia High blood cholesterol High blood cholesterol can be familial And associated with: Age, gender, inactivity and being overweight, low dietary fibre, smoking, ethnicity, low socioeconomic status and other diseases (hypertension, diabetes and chronic kidney disease) Management aims to lower LDL levels and raise HDL levels achieved through modifications to lifestyle factors Statins may be required Angina pectoris Severe chest pain caused by narrowing of the coronary arteries Myocardial ischaemia is associated with increased blood lactic acid Squeezing, crushing, gripping substernal pain (may radiate to left arm/jaw) May be stable or unstable Angina pectoris - management Relieved by rest or glyceryl trinitrate (GTN) medication Stimulates vasodilation Pain resolves in 2-3minutes Other medications may be required – Aspirin, calcium channel blockers, beta blockers, ACE inhibitors, statins Angioplasty or surgery to place stents or perform a coronary artery bypass graft may be required Myocardial infarction Heart attack or coronary thrombosis It is a sudden injury caused by blockage of a coronary artery Rupture of a vulnerable atheromatous plaque The resultant ischaemia (oxygen shortage) leads to necrosis (tissue death) of the myocardium Question What symptoms may alert you to someone having a myocardial infarction? Myocardial infarction – clinical presentation Severe, central crushing pain radiating to left arm or jaw May start at rest and persist Restlessness, facial pallor, sweating, nausea, vomiting, confusion and apprehension 10-20% of patients will have no pain (silent infarctions) Women may present with atypical symptoms Death soon after the onset of chest pain from ventricular fibrillation and cardiac arrest Myocardial infarction – management Call 999 for emergency assistance Immediate hospital admission Comfortable position for: GTN spray if known angina ECG, blood tests, echocardiogram Dispersible aspirin 300mg chewed Oxygen (unless clear evidence of allergy to Thrombolytic therapy it) Analgesics Oxygen if patient hypoxaemic Anticoagulants Monitor and be prepared to start ACE inhibitors CPR/AED Sedative Bed rest Surgery Myocardial infarction - complications Outlook depends on onset to treatment Acute - cardiac dysrhythmias, cardiac failure and pericarditis Later – angina, thromboembolism, aneurysm, cardiac rupture Longer term - post MI syndrome (known as Dressler’s syndrome), shoulder-hand syndrome, psychological problems and depression Cardiac arrest - consequences Cardiac arrest is a serious and often catastrophic event Cerebral hypoxia causes respiratory arrest and brain injury Survivors may have personality changes, memory and speech impairment, involuntary movements, incontinence Cardiac arrest Cardiopulmonary arrest Abrupt loss of heart function, breathing and consciousness Electrical malfunction when the the heart stops beating and prevents oxygen rich blood being pumped to the brain, lungs and other organs May occur after a myocardial infarction but often has other cause Cardiac arrest - management The longer the arrest the less the possibility of restoring healthy life Chain of survival CPR to provide circulatory support AED if shockable rhythm present (ventricular fibrillation or pulseless ventricular tachycardia) Question How do dental professionals ensure they maintain the level of knowledge to care for patients in an emergency? Comfort break Cardiac devices Implantable cardiac loop recorders Pacemakers Implantable cardioverter defibrillator Pacemakers Medical device that replaces or regulates the electrical conduction of the heart Generates electrical impulses delivered by electrodes causing the heart muscle to contract and pump blood https://www.youtube.com/watch? v=_fC8JQwm-UU Cerebrovascular disease Diseases and disorders that affect the blood vessels of the brain and the cerebral circulation Causes: Stenosis, thrombosis, embolism and haemorrhage Includes cerebrovascular accident (stroke) and transient ischaemic attacks (TIAs) Stroke and TIA Rapid onset and brain infarction Ischaemic stroke – caused by embolism from a distant site or thrombosis of a cerebral vessel Haemorrahgic stroke – caused by an intracerebral or subarachnoid bleed Transient ischaemic attack (TIA) - ‘mini stroke’ lasting