WK3 - Lecture 13 - Angina and MI PDF

DH 410 EMERGENCIES IN DENTAL PRACTICE Lecture: CAD & Angina & Myocardial Infarction (MI) Objectives  Understand and describe factors that may precipitate an Anginal Attack or Acute Myocardial Infarction  Differentiate between cardiac related and non- cardiac rela...

DH 410 EMERGENCIES IN DENTAL PRACTICE Lecture: CAD & Angina & Myocardial Infarction (MI) Objectives  Understand and describe factors that may precipitate an Anginal Attack or Acute Myocardial Infarction  Differentiate between cardiac related and non- cardiac related chest pain  Differentiate between symptoms associated with an Anginal Attack and AMI  Describe the procedure for management of a dental patient experiencing AMI and/or Cardiac Arrest Coronary Artery Disease  A type of heart disease that occurs when there is a reduced flow of oxygen to the heart  Ex. Due to Atherosclerosis  Most common cause of Chest Pain (cardiac origin)  Result in greatest number of deaths in U.S. yearly Atherosclerosis Risk Factors for Coronary Artery Disease (CAD)  Gender  Physical inactivity  Age  Tobacco  Heredity  High blood  Obesity pressure (HBP)  High cholesterol Gender  Males and females equally  Many women develop risks later in life (~10yrs) Age  Increasing age, greater risk  Incidence doubles with each additional decade of life  Equal for men and women  Heredity  Family history is a risk for CHD/CAD  Without family history, survival rate may be longer CHD – Coronary Heart Disease CAD – Coronary Artery Disease They can be used interchangeably, but CHD is the result of CAD Tobacco Use  Smoking & secondhand smoke a leading risk factor for mortality worldwide  Single most preventable cause of death in the U.S.  Secondhand exposure 20-30% more likely to develop CHD/CAD Hypertension  Direct relationship with hypertension and CHD  Estimated 46% of adults in the U.S have HBP Hypercholesterolemia  High blood cholesterol  Cholesterol – waxy, fat-like substance made in liver  Too much cholesterol results in atherosclerosis and CHD/CAD Diabetes  Common complication of diabetes is CHD/CAD due to atherosclerosis  Atherosclerosis accelerated and more severe in diabetics  75% of diabetics die from some form of CVD  CVD = Cardiovascular disease Obesity and Physical Activity  Risk factors for CHD/CAD  Obesity often results in Type 2 Diabetes  Weight control, diet, and exercise can reduce hypertension and hypercholesterolemia Angina Be sure you have watched the videos shared with you Angina Pectoris  Inadequate supply of oxygen to the heart  Typically due to atherosclerosis  Due to increase demand for oxygen  SYMPTOM of CHD/CAD  Common medical emergency in dental office Angina Pectoris  As plaque deposits increase in size, they restrict the opening of the artery, resulting in decreased oxygen to heart  Occlusion of the artery can result in an infarction  tissue not receiving blood dies Atherosclerosis Forms of Angina  Stable  Variant (Prinzmetal’s)  Unstable Stable Angina  AKA “typical” “chronic” “classic”  Etiology: Usually induced by physical activity or stress and symptoms are worse in cold weather or after a large meal  Responds to NITROGLYCERIN  Can receive dental care – appointments should be short and minimally stressful Variant Angina  AKA “Prinzmetal’s” “atypical”  Etiology: Coronary artery spasm  Occurs spontaneously, usually while person at rest and at odd hours of the day or night  More Common in women under 50 years  NITROGLYCERIN usually provides prompt relief Unstable Angina  AKA “intermediate coronary syndrome” “premature” “impending MI”  Etiology: progression of atherosclerosis  Middle ground between stable angina and MI  NITROGLYCERIN may or may not relieve symptoms  Signs and Symptoms Angina  Generalized chest discomfort  Dull pressure, burning, heaviness, squeezing, or choking  Discomfort radiates to left shoulder, arm, neck, lower jaw, or tongue  Diaphoresis (excessive sweating)  Signs and Symptoms Angina  Pallor  Nausea  Increased pulse and BP  Vary in intensity  Last 1 – 15 minutes  Treatment of Angina  Terminate treatment  Position: Semi-supine or upright  C-A-B: (circulation, airway, breathing)  Monitor & record vital signs  Administer oxygen, 4-6 L/minute via nasal cannula or non- rebreather bag  Treatment of Angina  Administer sublingual NITROGLYCERIN  dilates coronary blood vessels = lower cardiac workload  Use patient’s own medication if current  Will feel tingling sensation on tongue if fresh  Administer one tablet/spray every 5 minutes up to 3 doses  usually alleviates symptoms in 2-4 minutes  Caution: Nitroglycerine contraindicated in HYPOtensive patients Treatment of Angina  Following administration, patient may experience tachycardia, flushing, pounding in head, hypotension  May resume treatment post recovery  DDS and patient need to agree  If chest pain NOT relieved in anginal patient after second dose, contact EMS Anginal patient with nasal cannula to deliver oxygen Nitroglycerin Treatment of Angina – NO History  If chest pain occurs on a patient with no known anginal history, EMS should be contacted immediately and the steps for treatment of a known anginal patient should be followed Myocardial Infarction (MI/AMI) Be sure you have watched the videos shared with you  Acute Myocardial Infarction (AMI)  Necrosis of a portion of the myocardium due to total or partial occlusion of a coronary artery  Caused by atherosclerosis, thrombus, or spasm May form rapidly or over a period of time  MI can lead to cardiac arrest Blockage of coronary arteries  Acute Myocardial Infarction (AMI)  Cardiac dysrhythmia may occur after MI and is a high risk for death  Bradycardia  Ventricular tachycardia – rapid contraction with inadequate ventricular filling  Ventricular fibrillation – disorganized, irregular contraction of ventricles  Asystole – absence of heart contraction Signs and Symptoms of AMI  Classic symptom: chest pain lasting 20 minutes or longer  Severe pain  Pressure, tightness, heaviness, burning, squeezing, crushing sensation in middle of chest and/or lower 1/3 of epigastrium (upper abdomen, just above stomach)  Pain may radiate down left arm, shoulders, jaw, or back  Signs and Symptoms of AMI  Dizziness  Dyspnea  nausea, vomiting  Skin cool, pale, moist  Sense of impending doom  Palpitations  Clutching chest Treatment of AMI  Terminate procedure  History of angina  No history of angina  follow protocol for  contact EMS angina immediately Treatment of AMI  Position patient comfortably (upright or semi-supine)  Contact EMS  Monitor vital signs  Administer oxygen 4-6L/minute via nasal cannula  Administer nitroglycerine – 3 doses; 15 minute period  (or patient’s own, if they have it)  If pain diminishes and then returns, most likely AMI Treatment of AMI  Administer aspirin (chewable) 325 mg  antithrombotic effect – clinical effect reached in 20 minutes  Manage pain – nitrous oxide if available  If cardiac arrest occurs, perform CPR with AED Reference Malamed, S. F. (2022). Medical emergencies in the dental office. Elsevier. Little, J. W., Miller, C., & Rhodus, N. L. (2017). Little and Falace’s dental management of the medically compromised patient. Mosby. Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall