Term
|
Definition
| the thickening of the intimal layer of the arterial wall caused by the accumulation of lipid plaques |
|
|
Term
| What will atherosclerosis result in? |
|
Definition
| a narrowed arterial lumen with diminished blood flow and oxygen supply |
|
|
Term
| What is the most common underlying cause of not only coronary artery disease but also cerebrovascular disease and peripheral arterial disease? |
|
Definition
|
|
Term
| What is Symptomatic coronary atherosclerotic heart disease often is referred to? |
|
Definition
|
|
Term
| Ischemic symptoms are the result of... |
|
Definition
| oxygen deprivation secondary to reduced blood flow to a portion of the myocardium |
|
|
Term
| What disease is the leading cause of death in the United States after age 65? |
|
Definition
|
|
Term
| What is the etiology of coronary atherosclerosis? What are some risk factors? |
|
Definition
--No known etiology--
-male gender, older age, a family history of cardiovascular disease, hyperlipidemia, hypertension, cigarette smoking, physical inactivity, obesity, insulin resistance and diabetes mellitus, mental stress, and depression
Additionally, markers of inflammation, such as C-reactive protein, homocysteine, fibrinogen, and lipoprotein(a) |
|
|
Term
| What is a major risk factor for atherosclerosis? |
|
Definition
| elevation in serum lipid levels |
|
|
Term
| Increased LDL increases/decreases the risk of coronary atherosclerosis, HDL increases/decreases the risk of coronay atherosclerosis. |
|
Definition
LDL(low-density lipid protein)- increased levels of this increases the risk
HDL(high density lipoprotein)-increased levels of this decreases your risk |
|
|
Term
| Persons with elevated triglyceride or β-lipoprotein levels have an increased/decreased risk for the disease. |
|
Definition
|
|
Term
| Is high blood pressure a risk factor for coronary atherosclerosis? which one? |
|
Definition
|
|
Term
| What is the single most important modifiable risk factor for coronary heart disease? |
|
Definition
|
|
Term
| What are some other risk factors for the development of atherosclerosis? |
|
Definition
-Elevated levels of C-reactive protein (inflammatory marker)
-Fibrinogen (procoagulant)
-Plasminogen activator inhibitor (thrombolytic)
-Homocysteine |
|
|
Term
| Is perio disease related to heart disease? |
|
Definition
| studies have shown that they are related |
|
|
Term
| What plays fundamental role at all stages of heart disease? |
|
Definition
|
|
Term
| What is Atheroma formation is initiated by? |
|
Definition
| adherence of monocytes to an area of injured or altered endothelium |
|
|
Term
| What forms the deposits on the walls of the vessels? |
|
Definition
|
|
Term
| What happens after LDL's attach? |
|
Definition
| Macrophages then engulf lipid molecules to become foam cells, which are characteristic features of the fatty streak, smooth muscles then cover the plaque to protect it |
|
|
Term
| When is a thrombus formed? |
|
Definition
| when t lymphocytes weaken the cap and the plaque ruptures into the blood |
|
|
Term
|
Definition
| outwardly and inwardly into the lumen |
|
|
Term
| What happens with inward proliferation? |
|
Definition
| the lumen is greatly reduced in size, stenosis |
|
|
Term
| What is the outcome when the demand for oxygen exceeds supply? |
|
Definition
|
|
Term
| What happens when the plaque ruptures? |
|
Definition
| blood rushes to it, making the lesion greatly increase in size |
|
|
Term
| Does atherosclerosis occur in all of the arteries? |
|
Definition
| no, it occurs in certain arteries and others are uneffected |
|
|
Term
| What are some arteries effected by atherosclerosis? |
|
Definition
brain, heart, aorta, and peripheral arteries
**may be circumferentially or eccentriaclly narrowed** |
|
|
Term
| Do these plaques always cause disease? |
|
Definition
|
|
Term
| What can intact lesions cause? |
|
Definition
|
|
Term
| What can ruptured lesions cause? |
|
Definition
-angina at rest
-MI
-sudden death |
|
|
Term
| Intramural hemorrhage, which results from weakening of intimal tissues, may lead to... |
|
Definition
|
|
Term
| If the oxygen depravity is prolonged what can happen? |
|
Definition
| necrosis of the heart tissue |
|
|
Term
| What is the extent of involvement involved in? |
|
Definition
|
|
Term
| What is Elevation of the ST segment seen in? |
|
Definition
| in cases with more profound ischemia and a larger area of necrosis |
|
|
Term
| What is the most important symptom of coronary atherosclerotic heart disease? |
|
Definition
| chest pain(may be brief or prolonged) |
|
|
Term
| What does Ischemic pain result from? |
|
Definition
| an imbalance between the oxygen supply and the oxygen demand of the muscle |
|
|
Term
| What is the pain associated with angina pectoris like? |
|
Definition
| a sensation of aching, heavy, squeezing pressure or tightness in the midchest region |
|
|
Term
| Where is the pain associated with angina? |
|
Definition
| The area of discomfort is reported to be approximately the size of a fist and may radiate into the left or right arm, the neck, or the lower jaw |
|
|
Term
| How long does the pain associated with angina last? |
|
Definition
| The pain is of brief duration, lasting 5 to 15 minutes if the provoking stimulus is stopped or for a shorter time if nitroglycerin is used |
|
|
Term
|
Definition
| in terms of its pattern or symptom stability |
|
|
Term
| What is unstable angina defined as? |
|
Definition
| new-onset pain, pain that in increasing in frequency, pain that is increasing in intensity, pain that is precipitated by less effort than before, or pain that occurs at rest |
|
|
Term
| Is the pain from unstable angina relieved by nitroglycerin? |
|
Definition
|
|
Term
| What is myocardial ischemia that ranges from unstable angina at one end to non-ST segment MI at the other? |
|
Definition
|
|
Term
| When does Prinzmetal’s variant angina occur? What causes is? |
|
Definition
| occurs at rest, caused by focal spasm of coronary artery(usually with varied amounts of atherosclerosis) |
|
|
Term
| Patients with coronary atherosclerosis who experience prolonged pain as a result of myocardial ischemia usually have what? |
|
Definition
| unstable angina or an acute MI |
|
|
Term
| What is the pain for this like? |
|
Definition
| same general characteristics of stable angina but lasts more than 15 mins and is more severe |
|
|
Term
| Does the Use of vasodilators or cessation of activity relieve the pain caused by infarction? |
|
Definition
|
|
Term
| Is cardiac death caused by arythemia? |
|
Definition
| no, it is usually caused by ventricular fibrillation |
|
|
Term
| What are some symptoms of coronary atherosclerotic heart disease? |
|
Definition
-heart palpations
-syncope |
|
|
Term
| What are the symptoms of congestive heart failure? |
|
Definition
| dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema, hemoptysis, fatigue, weakness, and cyanosis |
|
|
Term
| Are there a lot of signs seen with of coronary atherosclerotic heart disease? |
|
Definition
| no, patient may appear completely normal |
|
|
Term
| Who are blood tests done in? |
|
Definition
| people with symptoms of angina |
|
|
Term
| What are some of these blood tests? |
|
Definition
-Complete blood count to rule out anemia
-Thyroid function tests to exclude hyperthyroidism
-Renal function tests to exclude renal insufficiency
-Lipid screening for hypercholesterolemia
-Glucose screening for diabetes
-Homocysteine level determination
-C-reactive protein assay |
|
|
Term
| What are some diagnostic modalities that are specific for coronary heart disease include? |
|
Definition
-Resting ECG
-Chest x-ray studies
-Exercise stress testing
-Ambulatory (Holter) electrocardiography
-Stress thallium-201 perfusion scintigraphy
-Exercise echocardiography
-Ambulatory ventricular function monitoring
-Cardiac catheterization and angiography |
|
|
Term
| What are necessary to establish the diagnosis of acute MI and to determine the extent of infarction? |
|
Definition
| serum enzyme determinations |
|
|
Term
| What are the serum markers of acute MI most commonly used in clinical practice? |
|
Definition
-troponin I
-troponin T
-creatine kinase isoenzyme (CK-MB)
**are released only when cell death or injury to the myocyte occurs** |
|
|
Term
| What are proteins that are derived from the breakdown of myocardial sarcomeres? |
|
Definition
| Troponins, good because they can differentiate between cardiac muscle damage and skeletal muscle damage |
|
|
Term
| When are Troponins detectible? |
|
Definition
| 2 to 4 hours after the onset of an acute MI |
|
|
Term
| What are some things that can be done to manage angina? |
|
Definition
-lifestyle changes
-control of systemic conditions |
|
|
Term
| What are patients with significant angina encouraged to do? |
|
Definition
-work short hours
-take rest periods
-get adequate rest
-take mild sedatives
-possibly change jobs to less stressful one |
|
|
Term
| What are some things that should be avoided in people with angina that can cause cardiac pain? |
|
Definition
-Cold weather
-Hot and humid weather
-Big meals
-Emotional upset
-Cigarette smoking
-Drugs (e.g. amphetamines, caffeine, ephedrine, cyclamates, alcohol) |
|
|
Term
| What are some common drug therapies for angina? |
|
Definition
-Nitrates (nitroglycerin or long-acting nitrates)
-Antiplatelet agents
-Statins
-β-adrenergic blockers
-Calcium channel blockers
-ACE inhibitors |
|
|
Term
|
Definition
| vasodilators, predominantly venodilators, and are a cornerstone of the pharmacologic management of angina |
|
|
Term
|
Definition
-tablet under tongue
-spray under tongue or on oral mucosa
**to prevent angina symptoms** |
|
|
Term
| What are calcium channel blockers effective in treating? |
|
Definition
|
|
Term
| How do calcium channel blockers work? |
|
Definition
| drugs decrease intracellular calcium, resulting in vasodilatation of coronary, peripheral, and pulmonary vasculature, along with decreased myocardial contractility and heart rate |
|
|
Term
| Who are Angiotensin-converting enzyme (ACE) inhibitors used for? |
|
Definition
| patients with coronary heart disease who also have diabetes, left ventricular dysfunction, or hypertension |
|
|
Term
| Regular use of aspirin in patients with stable angina... |
|
Definition
associated with a significant reduction in fatal events, and in patients with unstable angina, aspirin decreases the chances of fatal and nonfatal MI
(75-325 mg) |
|
|
Term
| WHat has been shown to have effects equivalent to those of aspirin? |
|
Definition
|
|
Term
| What is revascularization? |
|
Definition
| an surgery option for patients with stable or unstable angina(Procedures include percutaneous transluminal coronary angioplasty, stents, and coronary artery bypass grafting) |
|
|
Term
| What are the two types of stents currently available? |
|
Definition
-bare metal
-drug aluding stent(require long time use of aspirin) |
|
|
Term
| What surgery is an effective means of controlling symptoms in the management of unstable angina; it can improve the long-term survival rate in certain subsets of patients? |
|
Definition
| Coronary artery bypass surgery (CABG) |
|
|
Term
| How does bypass surgery work? |
|
Definition
| A segment of artery or vein is harvested or released from a donor site; it is then grafted to the affected segment of coronary artery, thus bypassing the area of occlusion |
|
|
Term
| What is recommended for heart attack patients? |
|
Definition
|
|
Term
| Treatment for patients with acute MI is determind by... |
|
Definition
| the extent of ischemia as reflected on the ECG, which shows the presence or absence of ST segment elevation |
|
|
Term
| what are the general medications taken for acute MI? |
|
Definition
-Nitrates
-Beta blockers
-Calcium channel blockers
-ACE inhibitors
-Lipid-lowering agents |
|
|
Term
| What is the drug of choice seen for pain with MI? |
|
Definition
|
|
Term
| Risk assessment for the dental management of patients with ischemic heart disease involves three determinants... |
|
Definition
1.Severity of the disease
2.Type and magnitude of the dental procedure
3.Stability and cardiopulmonary reserve of the patient |
|
|
Term
| What are some general management strategies for heart issues? |
|
Definition
-Short appointments in the morning
-Comfortable chair position
-Pretreatment vital signs
-Availability of nitroglycerin
-Oral sedation
-Nitrous oxide–oxygen sedation
-Profound local anesthesia
-Limited amount of vasoconstrictor
-Avoidance of epinephrine-impregnated retraction cord
-Effective postoperative pain control |
|
|
Term
| Is antibiotic prophylaxis suggested in patients who have had balloon angioplasty with placement of a coronary artery stent, or for those who have undergone a CABG procedure? |
|
Definition
|
|
Term
| Who should NSAID's be avoided in? |
|
Definition
| NSAIDs should be avoided in patients with established cardiovascular disease, especially those whose cardiac history includes an MI |
|
|
Term
| Who should dental care be postponed in? |
|
Definition
| For patients with symptoms of unstable angina or those who have had an MI within the past 30 days (major risk category), elective care should be postponed |
|
|
Term
| If a vascoconstrictor is necessary, how much can be used and in who? |
|
Definition
| patients with intermediate clinical risk factors and those taking nonselective beta blockers can safely be given up to 0.036 mg epinephrine (2 cartridges containing 1:100,000 epinephrine) at one appointment |
|
|
Term
| Are there any oral manifestations for heart problems? |
|
Definition
| none from the disease, just from medication |
|
|
