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N Topics Study 1st Revision 2nd Revision 1 Conginetal heart disease 2 Coronary Artery disease 3 Hypertension 4 Acute Rheumatic fever 5 Infective Endocarclitis 6 Heart failure 7 Cardiogenic shock 8 Syncope 9 peptic Ulcer TOPICS AND PROGRESS TRACKING PLAN1
Congenital Heart DiseaseCongenital Heart Disease ""CHD"CHD" Congenital Heart Disease "CHD"2 0.8% of the population is born with CHD. 40% resolve spontaneously (mainly small VSDs). 56–98% survive into adulthood with current surgical techniques. 4.Etiology Structural defect in the heart and great vessels, present at birth In adults: VSD & ASD (~20%), followed by PDA and pulmonary valve stenosis. Most common CHD overall = Bicuspid aortic valve + VSD. Most common cyanotic CHD = Fallot's Tetralogy. NB 1.Congenital heart block, ASD 2.No specific association 3.PDA, Pulmonary stenosis 4.No specific association 5.VSD 6.Coarctation of aorta 7.Septal defects 1.Genetic abnormalities 2.Irradiation 3.Maternal rubella 4.Premature infants 5.Down's syndrome 6.Turner's syndrome 7.Maternal alcohol abuse Causes Diseases 5.Classification Cyanotic Acyanotic Fallot's Tetralogy ⭐ (most common) Fallot's Trilogy Less common. Eisenmenger 's Syndrome Pulmonary Stenosis. Aortic Stenosis. VSD, ASD, PDA. Coarctation of the Aorta. Dextrocardia. 1.Definition: 2.Epidemiology 3.Common defects
NB 1.Digital clubbing Chronic hypoxia 2.Renal dysfunction Sclerotic glomeruli → ↑Creatinine + Proteinuria + Hyperuricemia 3. Gallstones ↑ RBC breakdown → ↑ Calcium bilirubinate stones 4.Hypertrophic osteoarthropathy Thickened periosteum + Scoliosis 5.Cerebrovascular events Embolic/Hemorrhagic + Brain abscess + Cognitive problems 6.Arrythmias Post-surgical scars or pressure/volume loads3 Type Definition Cause Central Arterial saturation <85% or >5g reduced Hb Right-to-left shunting / Reduced pulmonary flow Peripheral Bluish discoloration of extremities Vasoconstriction / Polycythemia / Poor cardiac output Differential Lower limbs only PDA with reversed shunt Cyanosis types: 6-When to Suspect CHD ?! 1.Age < 5 years 2.Hypertension in a child 3.Positive prenatal history 4.Associated congenital anomalies 5.Cyanosis since birth 6.Negative history of rheumatic fever 7.Thrill over the base (AS/PS) or 8. left parasternal (VSD) Explanations 7-Clinical presentation Other Clinical Manifestations: Signs Note that: Most important complication is Infective endocarditis
Chronic stable angina = initial presentation in ~50% of CAD patients. ACS (Acute Coronary Syndrome) = acute imbalance of myocardial O2 supply/demand.4 2. Risk Factors Type Definition Key Marker STEMI MI with ST elevation or new LBBB Enzyme rise NSTEMI MI without ST elevation Enzyme rise Unstable Angina New/worsening ischemia symptoms, ST depression/T inversion Normal biomarkers Age Gender (male) Family history Hypertension Smoking Type 2 DM Obesity Dyslipidemia (↑LDL-C) Lifestyle Coronary artery diseaseCoronary artery disease CADCAD Coronary artery disease CAD Non-modifiable 1.Definition Persons with atherosclerosis may be asymptomatic, present with angina, or develop ACS. ACS subtypes: Modifiable CAD is the Most common cause of death in developed world.
54. Management of Stable Angina: Type Key Marker Typical angina All 3 characteristics present Atypical angina 2 of 3 characteristics Non-anginal pain 1 or none 3- Anginal Pain — Clinical Features Character: heaviness / compressing / burning / squeezing / crushing / gripping Location: retrosternal or left-sided → radiates to shoulder, arm, jaw, epigastrium Trigger: exertion or emotion Relief: rest or nitrates Classification: Never: Localized Stitching or throbbing < 30 seconds Patient education Lifestyle modification Risk factor modification Prevention of cardiovascular events → Antiplatelets, lipid- lowering agents, ACE inhibitors (Clopidogrel if aspirin intolerance) Antianginal medications → Beta blockers, CCBs, Nitrates Myocardial Revascularization → PCI or CABG
3- Clinical Considerations: Visit duration: Brief (<30 min), avoid early morning/late afternoon. Position: Semi-supine; rise slowly (avoid orthostatic hypotension). Anesthesia: No intravascular injection; max 2 carpules with VC. Monitoring: BP + pulse oximetry as needed 4- If surgery needed: Anticoagulated patient: determine INR on the day of treatment. Antiplatelet patient: local hemostatic measures.6 5. Dental Management in IHD Antiplatelet/Anticoagulant Management: 1- General Timing Rules: Safety period: 6 months before any oral surgical procedure post-MI. Within 6 months + urgent treatment needed (extraction/RCT) → hospital setting only 2- Medications: Nitrates Patient brings them; preventive dose before LA; use if chest pain develops Very anxious patients Premedication: Diazepam 5-10mg night before + 1-2h before Warfarin Check INR day of treatment; keep <3.5; local hemostasis if surgery Aspirin/Clopidogrel - no stent, low risk Stop 7-10 days before surgery Aspirin/Clopidogrel - WITH stent Do NOT stop: ≥1 month (bare metal) / ≥12 months (drug-eluting) Drug interactions NSAIDs, Penicillin, Tetracycline, Metronidazole, and anticoagulants
7Avoid diathermy — if must use → bipolar preferred ICD programmed OFF before surgery → ON after Patient brings manufacturer ID card No electrical cords over patient's chest Unshielded pacemakers → cover with lead apron Know malfunction symptoms: dizziness / breathing difficulty / chest pain / pulse change → refer to cardiologist Monitor BP and pain throughout the intervention. Anticoagulants: stop heparin 6-12 hours before → resume 6 hours after bleeding stops. Anesthesia: minimal amount + epinephrine 1:100,000 or 1:200,000. If stroke symptoms appear → oxygen immediately + refer to hospital. 7.Stroke Patient — Dental Management 6.Cardiac Pacemakers — Dental Management 5- Local Hemostatic Measures: Bone wax, sutures, gelatin, oxidized cellulose, collagen, platelet- rich plasma, thrombin, fibrin sealants, electric/laser scalpel, tranexamic acid Anesthesia Caution: ⚠ Max 3 ml of 2% Lignocaine + 1:80,000 adrenaline
9 HypertensionHypertensionHypertension 1. Definition: Arterial hypertension in adults = persistent elevation of: Diastolic BP > 90 mmHg OR Systolic BP > 140 mmHg On at least two subsequent visits 2. Classification of BP Levels Category Systolic Diastolic Optimal <120 and <80 Normal 120-129 and/or 80-84 High normal 130-139 and/or 85-89 Grade 1 HTN 140-159 and/or 90-99 Grade 2 HTN 160-179 and/or 100-109 Grade 3 HTN ≥180 and/or ≥110 Isolated systolic HTN ≥140 and <90 3. Etiology: Primary (Essential) No identifiable cause Most common type Related to cardiovascular risk factors Secondary Renal: Renovascular, Glomerulonephritis, Chronic nephritis Endocrine: Hyperaldosteronism, Pheochromocytoma, Hypo/Hyperthyroidism, Cushing Vascular: Coarctation of aorta Pregnancy Drugs: Contraceptive pills, Corticosteroids,
Ν.Β.: Systolic blood pressure depends on COP (stroke volume x heart rate). Diastolic component depends on P.R and blood viscosity. 6. Clinical Picture Usually asymptomatic,or presents with complications: Heart failure (Dyspnea) Stroke (weakness of one side) Encephalopathy (loss of consciousness) Angina (chest pain). High normal / Prehypertension Systolic 120–139 / Diastolic 80–89 Isolated systolic HTN Systolic > 140, Diastolic normal — common in elderly due to ↑ arterial stiffness Isolated diastolic HTN Rare White coat HTN BP > 140/90 in office only, ambulatory reading < 135/85 Masked HTN Normal in office, elevated elsewhere — linked to alcohol/smoking Pseudohypertension Stiff calcified vessels → falsely high reading — seen in elderly + long-standing DM 10 5. Causes of Systolic HTN: 8. Major Risk Factors:7.Target Organ Damage: Heart → LVH / Angina / MI / Heart failure Brain → Stroke / TIA Kidney → Nephropathy Peripheral arteries → Peripheral arterial disease Eyes → Retinopathy Smoking Dyslipidemia Diabetes Mellitus Age > 60 Male / Postmenopausal female Family history of CVD (Men <55 / Women <65) 4. Subtypes of Primary HTN: Atherosclerosis → ↓ arterial compliance Thyrotoxicosis Complete heart block → ↓ HR → ↑ stroke volume → ↑ systolic BP Aortic incompetence
Usually asymptomatic,or presents with complications: Heart failure (Dyspnea) Stroke (weakness of one side) Encephalopathy (loss of consciousness) Angina (chest pain). High normal / Prehypertension Systolic 120–139 / Diastolic 80–89 Isolated systolic HTN Systolic > 140, Diastolic normal — common in elderly due to ↑ arterial stiffness Isolated diastolic HTN Rare White coat HTN BP > 140/90 in office only, ambulatory reading < 135/85 Masked HTN Normal in office, elevated elsewhere — linked to alcohol/smoking Pseudohypertension Stiff calcified vessels → falsely high reading — seen in elderly + long-standing DM 6. Clinical Picture 11 5. Causes of Systolic HTN: 8. Major Risk Factors:7.Target Organ Damage: Smoking Dyslipidemia Diabetes Mellitus Age > 60 Male / Postmenopausal female Family history of CVD (Men <55 / Women <65) 4. Subtypes of Primary HTN: Atherosclerosis → ↓ arterial compliance Thyrotoxicosis Complete heart block → ↓ HR → ↑ stroke volume → ↑ systolic BP Aortic incompetence Heart → LVH / Angina / MI / Heart failure Brain → Stroke / TIA Kidney → Nephropathy Peripheral arteries → Peripheral arterial disease Eyes → Retinopathy Ν.Β.: Systolic blood pressure depends on COP (stroke volume x heart rate). Diastolic component depends on P.R and blood viscosity.
Smoking & Alcohol Stop Diet ↓ Salt / ↑ Potassium / ↑ Calcium / ↑ Fresh vegetables & fruits / Low-fat dairy Weight Reduction Exercise walking 30–45 min most days + relaxation exercise 12 9. Management....Lifestyle Modification 10. Management of Rapid Severe HTN