TABLE OFSyncope HF CONTENTS 01 02 03 04 05 CHD CAD HTN ARF IE 06 07 08 peptic ulcer1

1- Give short account on classification of CHD? Congenital Heart Disease (CHD) is classified into two main categories: Cyanotic: * Fallot's Tetralogy (most common). * Fallot's Trilogy. * Eisenmenger's Syndrome. Acyanotic: * Pulmonary Stenosis. * Aortic Stenosis. * VSD (Ventricular Septal Defect), ASD (Atrial Septal Defect), and PDA (Patent Ductus Arteriosus). *Coarctation of the Aorta. 2- Enumerate other clinical manifestations of (CHD)? Digital clubbing Renal dysfunction. Gallstones. Hypertrophic osteoarthropathy. Cerebrovascular events, like brain abscesses. Arrythmias. اﺪﻛ ﻲﺒﻨﻟا ع ﻞﺻ ﻚﺒﻠﻗ ف :)ﺮﻴﻤﻀﺑ ﻆﻔﺣوا CHDﻦﺘﻳر ﺔﻠﺌﺳا ﻪﻴﻓ شﺎﺠﻣ طﺎﻴﺘﺣﻼﻟ ﺲﺑ اﺪﻛ ﻞﺒﻗ 2

1- Dental management in patients with CAD (IHD): اﺪﺟ ﻢﻬﻣ 1. Timing & Scheduling Post-MI Safety: Wait 6 months for elective oral surgery; urgent care within this period requires a hospital setting. Appointments: Keep visits brief (<30 min) and avoid early morning or late afternoon slots. 2. Clinical Procedures Positioning: Use a semi-supine position and have the patient rise slowly to prevent orthostatic hypotension. Monitoring: Track blood pressure and pulse oximetry during the intervention. Anesthesia: Use a maximum of 2 carpules with a vasoconstrictor and ensure no intravascular injection. 3. Medication Management : ( اﺪﺟ ﻪﻴﻠﻋ ﺰﻛﺮﺘﺑ رﻮﺘﻛﺪﻟا ﺐﺘﻜﺘﻳ ءﺰﺟ ﻢﻫأ) Anxiety: Premedicate with Diazepam (5–10 mg) the night before and 1–2 hours before the visit if needed. Antiplatelets: Stop Aspirin/Clopidogrel 7–10 days before surgery for low-risk patients without stents. Stents: Do NOT stop antiplatelets if a bare-metal stent was placed ≥1 month ago or a drug-eluting stent ≥12 months ago. Anticoagulants: Ensure INR is <3.5 on the day of treatment for patients on Warfarin. 4. Emergency Protocol for Chest Pain Immediate Action: Stop treatment, provide 3 L/min Oxygen, and administer 0.4–0.8 mg sublingual nitrite. Follow-up: If pain persists after 5 minutes, give a second dose; if it continues for 15 minutes, transport the patient to a hospital. CAD 3

2- Enumerate risk factors of (CAD)? Non-modifiable Risk Factors: Age Gender (specifically male ) Family history Modifiable Risk Factors: Hypertension Smoking Type 2 Diabetes Mellitus (DM) Obesity Dyslipidemia (specifically increased LDL-C) Lifestyle 3- Dental management in cardiac pacemakers: Preparation & Documentation Identification: Patients must bring their manufacturer ID card. ICD Settings: Program the ICD OFF before surgery and ON immediately afterward. Equipment & Electrical Safety Cords: Do not place electrical cords over the patient's chest. Shielding: Cover unshielded pacemakers with a lead apron. Diathermy: Avoid use if possible; if necessary, bipolar is preferred. Clinical Procedures Anesthesia: Limit to a maximum of 3 ml of 2% Lignocaine with 1:80,000 adrenaline. Hemostasis: Use local measures such as bone wax, sutures, gelatin, collagen, thrombin, or tranexamic acid. Immediately refer to a cardiologist if the patient experiences: Dizziness, Breathing difficulty, Chest pain, or Changes in pulse. 4ﻆﻔﺤﺘﻫ شﺮﻜﻔﺘﻣ ﺶﻣ ازاي دا ﻞﻛ ﻆﻔﺤﺗ زمﻻ ف ﺎﻬﻠﻛ ﺔﻠﺌﺳﻻا :/ﺪﺣوا مﻮﻳ

4- Dental management for stroke patients : Monitoring: Blood pressure and pain levels must be monitored throughout the entire intervention. Anesthesia: Use a minimal amount of local anesthesia combined with epinephrine at a concentration of 1:100,000 or 1:200,000. Anticoagulant Management: If the patient is on heparin, it should be stopped 6–12 hours before the procedure and can be resumed 6 hours after bleeding has stopped. Emergency Protocol: If symptoms of a stroke appear during treatment, immediately administer oxygen and refer the patient to a hospital.ﺪﺧ يﺪﻌﻣ ﺖﻧوا ﻪﺴﻤﺧ ﻚﻳﺮﺑ تﺎﻓ ﻲﻠﻟا ع ﻊﺟرا 5

1- Dental management in hypertensive patients: اااﺪﺟ ﻢﻬﻣ Pre-Treatment Evaluation: Record medical history, BP, and HR at every visit. BP <160/100 mmHg: proceed normally. BP >160/100 mmHg: postpone elective care and refer to physician. Emergency (160-180 mmHg): treat only if pain-related, with BP monitoring every 10-15 min. Signs of hypertensive crisis (headache, visual changes, SOB, chest pain) → immediate emergency referral Appointment Management Prefer short morning appointments. Reduce anxiety; Diazepam may be used if needed. Continue antihypertensive medications on the treatment day. During Treatment Limit adrenaline (vasoconstrictor) to 0.04 mg maximum. Monitor BP during long/complex procedures. Prevent orthostatic hypotension: advise patients to stand slowly. up Medication Considerations Limit NSAIDs to ≤5 days as they may increase BP and reduce antihypertensive effectiveness. 2- Enumerate target organ damage: Heart → Angina / MI / Heart failure Brain → Stroke / TIA Kidney → Nephropathy Peripheral arteries → Peripheral arterial disease Eyes → Retinopathy HTN 6

1- Give short account on clinical manifestations of (ARF) And diagnostic criteria according to Jones: ﻢﻬﻣ Major Manifestations Polyarthritis (75%): Migratory inflammation of large joints (e.g. knees, ankles) that leaves no permanent damage. Carditis (40-50%): Inflammation of all heart layers (pan- carditis), often presenting as a new murmur or heart failure. Sydenham’s Chorea: Jerky, uncoordinated movements of the limbs and face that disappear during sleep. Subcutaneous Nodules (<2%): Small, firm, painless bumps on extensor surfaces. Erythema Marginatum: A transient, pink, circular rash found on the trunk and limbs. Minor Manifestations Arthralgia (joint pain without swelling). Fever (≥ 102°F). Elevated acute-phase Diagnosis (Jones Criteria): A definitive diagnosis in first episode requires: two major manifestations one major + two minor manifestations, + evidence of a preceding Group A Streptococcal (GAS) infection. for recurrence diagnosis: Only one major or several minor manifestations. ARF 7

3- Discuss treatment of ARF: General Care: Absolute bed rest is required. GAS Eradication: A 10-day course of Penicillin V, Amoxicillin, or a single IM injection of Benzathine Penicillin to eliminate the initial infection. Symptom Management: Arthritis: High-dose Salicylates (100 mg/kg/day) for 3–5 days, then tapered. Carditis: Severe cases are treated with Prednisone (2 mg/kg/day); heart failure managed with conventional measures. Chorea: self limited but if sever treated with Valproic acid or Carbamazepine. Jones Criteria (1992) WHO Criteria (2001) First episode 2 major OR 1 major + 2 minor + GAS evidence Same as Jones Chorea / Indolent carditis No GAS evidence needed No GAS evidence needed Recurrent RHD 1 major OR several minor + GAS evidence no RHD: Same as Jones WITH RHD:2 minor only + GAS evidence 2- compare between / discuss Jones and WHO diagnostic criteria in ARF: 8

4- Discuss 1ry and 2ry prophylaxis of ARF ﺎﻨﺴﻔﻧ ﻦﻣﺄﻧ ﻮﺿﺮﺑ زمﻻ دﺪﺠﺗ ﺮﻜﻔﺗ رﻮﺘﻛﺪﻟا ﺎﻤﺑﺮﻟ ﺲﺑ اﺪﻛ ﻞﺒﻗ شﺎﺠﻣ: Primary Prevention: The goal is to prevent the initial onset of ARF by treating (GAS) pharyngitis through: Penicillin V: Orally for 10 days. Amoxicillin: Orally for 10 days. Benzathine Penicillin G: A single IM injection. Allergy Alternatives: Cephalexin, Clindamycin, Azithromycin, or Clarithromycin. Secondary Prevention: The goal is to prevent recurrent ARF episodes through long- term antibiotic prophylaxis through: Benzathine Penicillin G (1.2 million units IM every 4 weeks). Oral Alternatives: Penicillin V (250 mg twice daily), Sulfadiazine, or Macrolides if allergic. Duration of Prophylaxis: ARF without carditis: 5 years or until age 21 (whichever is longer). ARF with carditis (no residual disease): 10 years or until age 21 (whichever is longer). ARF with carditis and residual heart disease: 10 years or until age 40 (whichever is longer). 9

1- Diagnostic schemes according to the modified Duke criteria for diagnosis of infective endocarditis and what are the criteria of definite IE. ﺺﻨﻟﺎﺑ رﺮﻜﺗوا اﺪﺟ ﻢﻬﻣ Major Manifestations Positive blood cultures (typical organisms from 2 separate cultures). Imaging positive (echocardiogram showing vegetation, abscess, or perforation). Minor Criteria Predisposing heart condition or IV drug use. Fever > 38°C. Vascular phenomena (such as emboli or Janeway's lesions). Immunological phenomena (such as Osler's nodes or Roth's spots). Diagnosis of definite IE: 2 major criteria Or 1 major + 3 minor or 5 minor criteria. IE2- what are the criteria of definite possible, and rejected IE ف ﻢﻬﻨﻣ هﺪﺣو ﺖﺒﻠﻃو تﺮﻴﻏ رﻮﺘﻛﺪﻟا ﻮﻟ نﺎﺸﻋ ﻢﻬﻨﻴﻓرﺎﻋ نﻮﻜﻧ ﻢﻬﻣ تﺎﻓ ﻲﻠﻟا الﺆﺴﻟا Diagnostic Classifications: Definite IE: 2 major or 1 major + 3 minor or 5 minor criteria. Possible IE: 1 major + 1 minor OR 3 minor criteria. Rejected IE: Firm alternate diagnosis, OR symptoms resolving in ≤4 days of starting antibiotics 10

3- Enumerate clinical features of IE: Fever Heart murmurs Myo-skeletal symptoms (including arthralgia, myalgia, and back pain) Splinter hemorrhages Osler's nodes Janeway's lesions Conjunctival hemorrhage Roth's spots Systemic embolism Heart failure 4- Cases for which prophylaxis is not required ﺐﻳﺮﻗ ﻦﻣ ﻪﺟ: Dental Procedures and Events: Routine local anaesthetic injections through non-infected tissue. Dental radiographs (X-rays). Placement or adjustment of orthodontic or prosthodontic appliances. Shedding of deciduous teeth. Cardiac Conditions: Native valve disease (such as Aortic Stenosis [AS], Mitral Stenosis [MS], or Mitral Valve Prolapse [MVP]). All other forms of Congenital Heart Disease (CHD) 11

5- The high-risk cardiac conditions where antibiotic prophylaxis is required before specific dental procedures include: Prosthetic cardiac valve. Previous infective endocarditis. Unrepaired cyanotic congenital heart disease (CHD), including palliative shunts. Repaired CHD with prosthetic material within the first 6 months of the procedure. Repaired CHD with residual defects remaining at the prosthetic site. 6- Antibiotic prophylaxis before dental procedures: Standard Oral Regimen Amoxicillin: 2 g for adults; 50 mg/kg for children. 2. Unable to Take Oral Medications Ampicillin: 2 g IM/IV for adults; 50 mg/kg for children. Cefazolin or Ceftriaxone: 1 g IM/IV for adults; 50 mg/kg for children. 3. Penicillin-Allergic (Oral) Clindamycin: 600 mg for adults; 20 mg/kg for children. Azithromycin: 500 mg for adults; 15 mg/kg for children. 4. Penicillin-Allergic & Unable to Take Oral Medications Cefazolin or Ceftriaxone: 1 g IM/IV for adults; 50 mg/kg for children. Clindamycin: 600 mg IM/IV for adults; 20 mg/kg for children. 12

1- Discuss classifications of Heart failure: 1.By Ejection Fraction (Echo): Systolic HF: Heart failure with reduced EF (< 40-5%). 2- Diastolic HF: Heart failure with preserved EF (> 40-50%). 2.Anatomical / Clinical: Left HF: Involves fluid retention and pulmonary edema in the pulmonary veins. Right HF: Involves fluid retention and peripheral edema in the systemic veins. Congestive HF: Begins in the left side and then refers to the right. 3.By Cardiac Output: Low Cardiac Output HF. High Cardiac Output HF: Caused by anemia, thyrotoxicosis, sepsis, or AV shunts. By Onset & Duration: Chronic HF: Slow onset. Acute HF: Fast onset. 2- Enumerate causes of HF: HF Hypertension Cardiomyopathies Infectious diseases Alcohol Coronary artery disease Valvular heart disease Congenital heart disease Tobacco & cocaine (↑ CAD risk) 3- Enumerate predisposing factors of HF: Arrhythmia Anaemia Thyrotoxicosis Infection IV fluids Pregnancy / Pills Rheumatic activity Infective endocarditis Negative inotropic drugs Discontinuation of digitalis 13

1- Discuss causes of syncope: 1.Cardiac: Exertional (obstruction): AS, HOCM At rest (arrhythmias): Adams-Stokes, brady/tachycardia Decreased venous return: Hemorrhage, burns, peripheral vasodilation Positional: Ball & valve embolus, left atrial myxoma 2.Vasomotor: Vasovagal attack, carotid sinus syndrome 3.Orthostatic: Autonomic neuropathy, huge varicose veins, hypovolemia (hemorrhage/dehydration), leg muscle weakness 4.Cerebral: Cerebral embolism, hyperventilation 5.Hypoxia: Marked hypoxia (e.g., Fallot's tetralogy) 6.Other: Cough, micturition, autonomic epilepsy. Syncope 14

1- Discuss treatment of peptic ulcer: 1.Lifestyle: Stop smoking and avoid traditional NSAIDs (switch to selective COX-2 inhibitors if analgesics are required). 2.Acid Suppression: Antacids. H2 Blockers (4–6 weeks): Ranitidine or Famotidine. Proton Pump Inhibitors (PPIs): Omeprazole, Pantoprazole, or Lansoprazole. 3.H. pylori Eradication: First-line: PPI + Clarithromycin + (Metronidazole or Tinidazole) + Amoxicillin. Quadruple therapy: PPI (twice daily) + Bismuth (subsalicylate/subcitrate) + Metronidazole + Tetracycline. 2- Enumerate Differential diagnosis of peptic ulces: Pancreatitis Cholecystitis GERD / gastric cancer Inferior wall MI/ischemia Peptic ulcer 15

ﻦﻤﻓ ﺎﻧﺄﻄﺧأ وإن ﷲ ﻦﻤﻓ ﺎﻨﺒﺻأ ان .نﺎﻄﻴﺸﻟا ﻦﻣو ﺎﻨﺴﻔﻧا أن ﺪﻬﺷأ كﺪﻤﺤﺑو ﻢﻬﻠﻟا ﻚﻧﺎﺤﺒﺳ بﻮﺗوأ كﺮﻔﻐﺘﺳأ ﺖﻧأ ﻻإ ﻪﻟإ ﻻ .ﻚﻴﻟإ DECODE ،ﺔﻨﻃﺎﺒﻟا ﻦﻣ ءﺎﻬﺘﻧﻻا ﷲ ﺪﻤﺤﺑ ﻢﺗ .🤍ﺐﻴﻐﻟا ﺮﻬﻈﺑ ةﻮﻋد ﻦﻣ ﺎﻧﻮﺴﻨﺗ ﻻ

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