The Patient with a Cardiovascular Disease

Introduction
Cardiovascular includes diseases of the heart and blood vessels
A heart disease may be present for many years before symptoms occur; we may see
patients who have no obvious symptoms or those nearly disabled
Studies have shown there MAY be a link between periodontal inflammation and
cardiovascular disease and point to the need for maintenance of healthy oral tissues and
to prevent periodontal infections
Healthy Heart

Blood flows in one direction as each chamber contracts, the valves acts as a trap door that
close after each contraction to prevent backflow of blood
Right side contains deoxygenated blood from the body to the lungs
Left side contains oxygenated blood from the lungs being pumped out of the aorta on the
way to the body
Septal wall divides the left and right side of the heart

Congestive Heart Failure

A condition in which the heart is unable to perform the work necessary to keep up with the
bodys needs and could be the result of different types of heart disease such as coronary heart
disease, heart valve disease like aortic stenosis, cardiomyopathy, and cardiac arrhymias
o Etiology: the most common causes in the United States is coronary artery disease,
high blood pressure, longstanding alcohol abuse, and disorders of the heart valves
o Occurrence: 4.8 million people in the US have congestive heart failure with poor
50% that will only have a 5 year survival rate
o Signs and symptoms: dyspnea, edema, weakness, fatigue, and lightheadedness
depending on which side of the heart is effected
o Treatment: fluid restriction and decrease in salt intake, lifestyle modifications,
addressing potentially reversible factors, medications, and heart transplant or
mechanical therapies
o Medications:
ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs
(angiotensin receptor blockers) both of these decrease systemic
resistance and reduce blood pressure
Beta blockers lowers the heart rate and increase cardiac output
Digoxin helps increase cardiac output and control symptoms

Ischemic Heart Disease

AKA Coronary Heart Disease
Etiology- a decrease in blood flow (atherosclerosis) which
narrows the lumen. This occurs by accumulation of liquid
plaque inside one or more of the blood vessels that carry
oxygen to your heart.
Occurrence- Affects 4 million people in the US. Leading
cause of death after the age of 40 or 50. About 610,000
people die of heart disease in the US every yearthats 1 in
every 4 deaths. Mostly in African Americans, Hispanics, and

Whites
Signs and Symptoms:
- Angina or chest pain
- Shoulder or arm pain
- Fast heart beat
- Nausea
- Weakness or dizziness

- Shortness of breath
- Pain in the neck or jaw
- Palpitations
- Sweating
- Clammy skin

Risk Factors:
- Hypertension
- Tobacco use
- Diabetes
- Obesity

- Hyperlipidemia
- Lack of exercise
- Genetics
- Age (45-men & 55-women)

Prevention/Management:
- Healthy diet
- Tobacco cessation
- Reducing cholesterol

- Exercise
- Manage diabetes
- Maintain blood pressure

Treatment:
- Surgical procedures
Angioplasty and stent placement- procedure to remove plaque and restore blood flow in
clogged arteries
Coronary artery bypass graft- procedure that helps restore blood flow to the heart by
routing the flow through transplanted arteries
- Medications
Medications used in treatment & how they impact oral health:
- Angiotensin-converting enzyme (ACE) inhibitors- relaxes the blood vessels and lower blood
pressure; burning mouth, taste loss, dry cough
- Angiotensin receptor blockers (ARBs)- lowers blood pressure; taste loss
- Anti-ischemic agents such as ranolazine (Ranexa); xerostomia

- Antiplatelet drug- prevents the formation of blood clots; prolonged bleeding

- Beta-blockers- lowers the heart rate; xerostomia
- Calcium channel blockers- reduces workload on the heart muscle; drug-induced gingival
enlargement
- Nitrates- dilates the blood vessels; xerostomia
- Statins- lowers cholesterol; xerostomia
Dental Concerns:
Contraindications
- Acute or recent myocardial infarction within the preceding 3 to 6 months
- Unstable or the recent onset of angina pectoris
- Uncontrolled heart failure or arrhythmias
- Significant, uncontrolled hypertension- blood pressure reading higher than 180/110
Periodontal Management
- Emergency treatment should only occur after a consult with the patient's cardiologist to assess
cardiac status prior to treatment
- Scaling and root debridement are low-risk procedures but, maxillofacial surgery with general
anesthesia is a high-risk dental procedure.
- Use of anti-anxiety medications taken 1 hour before the appointment. Some patients may be
best served by taking a nitroglycerin tablet prior to certain stress-provoking dental procedures.
- Nitrous oxide/oxygen sedation is an effective method for controlling anxiety and stress during
the appointment.
- During the appointment, the patient's nitroglycerin spray or tablets should be easily available so
it can be reached.
Expected and Accepted Treatment Options
- Pre-med- consult with cardiologist
- Patient Positioning- semi Supine
- Appointment length- short, stress-free, mid-morning/afternoon appointments
- Ultrasonic use- avoid in implantable cardioverter defillators (ICD) and pacemakers
- Recall Intervals- 3 months
- Anesthesia-epinephrine (0.04 mg) can provide safe, long-lasting pain control during scaling and
root debridement for most patient

Questions
1. Congestive heart failure is a condition in which the heart is unable to perform
the work necessary to keep up with the bodys needs, but is not the same as heart
failure.

A. Both statements are false

B. Both statements are true
C. The first statement is false and the second statement is true
D. The first statement is true and the second statement is false

2. Ischemic heart disease occurs from atherosclerosis and is the accumulation of lipid plaques inside the
blood vessels.

A.
B.
C.
D.

Both statements are true

Both statements are false
The first statement is true and the second statement is false
The first statement is false and the second statement is true

3. All of the following are signs and symptoms of Myocardial Infarction EXCEPT:
A. Cold sweat
B. High blood pressure
C. Anxiety
D. Cyanosis

References
Beckerman, James. "Coronary Artery Disease-Topic Overview." WebMD. WebMD, 30
September 2014. Web. 16 November 2016. http://www.webmd.com/heart-disease/tc/coronary-arterydisease-overview

Darby, Michelle L. Mosbys Comprehensive Review of Dental Hygiene, 4th edition. Missouri:
Mosby, Inc, 1998. Pg 558-589. Print.
N.P. Cardiovascular Disease. Colgate-Palmolive Company. 2015. Web. 16 Nov. 2016.
http://www.colgate.com/en/us/oc/oral-health/conditions/heart-disease/article/cardiovascular
Tolle, Susan N, BSDH, MS; Walters, Amber N, RDH, DSDH, MS. "Strategies for the Safe
Treatment of Cardiovascular Patients." Dimensions of Dental Hygiene., 15 March
2015.;13(3):44-47 Web. 16 November 2016.
<http://www.dimensionsofdentalhygiene.com/ddhnoright.aspx?id=20623&term=ischemic>
Wilkins, Esther M. Clinical Practice of the Dental Hygienist, 11th edition. Philadelphia:
Lippincott Williams & Wilkins, 2013. Pp 1006-1007, 1014-1015- 1021. Print.