Professional Documents
Culture Documents
Unstable Angina
Is that in which there are changes in pattern, frequency or
duration of precipitating factors, sudden onset angina is
considered to be unstable.
Prinzmetal’s Angina
Is angina at rest, commonly at night and is caused by coronary
artery spasm.
CLINICAL FEATURES
• More common in males
• Age 40 to 60 years
• Tightness, heaviness, compression or constriction of the chest may
be complaints but the pain is rarely of the unbearable, crushing and
persistent nature of myocardial infarction.
• The typical site is behind the sternum radiating to the left
particularly, sometimes to the left upper arm and occasionally to left
mandible, teeth, tongue or palate.
• Patients who develop angina often have no history of heart disease
• The mortality rate in angina is about 4 percent per year.
SIGNS AND SYMPTOMS
1. Substernal pain or pain referred to arms, neck or
abdomen.
2. Pain lasting less than 15 minutes and possibly
radiating to the left shoulder.
3. Positive response to nitroglycerine.
4. Vital signs are normal
5. No hypotension, sweating or nausea occurs
POTENTIAL PROBLEMS RELATED TO
DENTAL CARE
1. Stress and anxiety related to dental visit could precipitate
an anginal attack, MI, or sudden death in the office.
2. For patient taking a non-selective beta blocker, the use of
excessive amount of epinephrine could precipitate a
dangerous elevation of blood pressure.
3. Patient taking aspirin or other platelet aggregation inhibitor
could experience excessive bleeding.
4. Potential to cause endarteritis of coronary artery stent in the
immediate post-placement period exists as a result of
dentally induced bacteremia.
ORAL MANIFESTATIONS
Unstable Angina
Dental RX should be limited to that which is
absolutely necessary, such as for infection or pain.
Stable Angina
Any desired dental treatment may be provided
taking into consideration appropriate management
considerations.
ANGINA IN DENTAL OFFICE
• If a patient experiences chest pain, dental RX must be
stopped.
• If there is history of angina, the patient should be
given glyceryl trinitrate 0.5 mg. sublingually and
oxygen, and be kept sitting upright.
• Vital signs should be monitored.
• The pain should be relieved in 2-3 minutes, the
patient should then rest and be accompanied home.
• If chest pain is not relieved within about 5 minutes,
myocardial infarction is the probable cause and
medical help should be summoned
ADVICE TO PATIENTS WITH ANGINA
To be Done Not to be Done