4. ATITUDINEA FATA DE AFECTIUNILE CARDIO-VASCULARE IN CABINETUL DE MEDICINA DENTARA ror ALEXANDRU BLUR, Po de Makta VoRONEAN Sf ad THRU NIT, Se ere. VierOR GTA Asis ide OCTAVIAN DINEA, Asst enn de CRISTIAN VEDA Ait un de COSMINTOTAN, Ait ani eM BOcDAS Bc Puologia aries inode muliple ens cin, ine acesa le mai event practinsnmatlogc id iperensunea aval Ceronaopatie Tnsfiiena carat. Arie crise Valeloptite HIPERTENSIUNEA ARTERIALA, Ese um sind crater pein ereeren pes ansale si- tole sa el instoie pest varie normale. OS. colder aloe ‘normale pen peesincs arial main 180-160 mg Gere inp ia as In raport ce wists reuse), ar entry minima 9098 ma In fine de etloge, hpertersunce aera se clastic 1 ipetensune ares eel, ae a ep entiica coca rani: + hieresine ater secundar de cart renal biperesinile renova (nami ‘congenial ale vase real, tomoze ct), hips Sul dn ttle paenchimnist rena (lomerlanetits seth i roid, abe, pielnete ee) = de cau enfosinte foeromocto,bipraldostroism ‘iar (adnom coieosyarenal cu secreie excess de loscon, inom Cushing hipertioin; = incor gravida eos prime sarin poate aprea ‘hipeesiune ever, eidvind event eu Scere oul sig: = peurogend (fein taumie, nimorle sau inl rer, {Gs cauz crdosaseular:coactae de sb, bloc com le, nici atid te. Se pot rt in eabietal de media dena pacieni cs hiper= ‘ersane aris contol mediamentn, in absena ltr fej care ‘vinifera, Conduit in cabinet de medicing enters: + const carfologic efertuatininea waameatuitstomte- Jog ch maxim ol dat set nterval emp a sven m0 “Ses lest genre a posters, se rept const aioli ‘+ sdinisare irs rterspre a matical de is, ines tn i iter! stomatlopic eu excopa medic! anticoagulant five va fi modified de cite medi cardnlog, sb consol ouglogtn). Administra. adult asealico™ (spina) se Tnverape pert 7 lel cet sca cicoguiatmistl o considers sbi nt fin fies petra cae a fest reeomandst) 1 nsurarea peso arse insite inoepr atamenul somaclogiy se temporienrStatmentl dict presunea ares este‘ni mare eu 20-30 mang fa de valor esionale abit le pas nul, solicidndese reevaluea earolgicn, De setencs se vie ‘cv tot pie co tens aneile mime ~160 my ad ferent de valle tnsnale abit sau cu fovea cadacd > 10 ‘aalgeie optima - analyte aninfamatrnestridian aie isa pe 0, rasa amen tomato, 1 premediie ow ansolice de ipl dear de benz Aiuzpine (Mizlam eomprinate 7.5 mg per 08 0 ok Tinted mere) ‘+ anesteze loa de cali; asin de vacant subsin anestericd fa concentra de maximum 1100 00, fi a epi dora de 0.2 mg Adrenalin. Nu se foloete Noradenlin ca + thd upet is nderina moti : rica hipertensivd (ve si sectunes Ugsnts malcle: Urgenfle ipenensve")| hia hipeesiva reprezns cree brs vali tenis ei, ex real de prodocer de Tes le organo fia (cond, ‘ich rie, cieuai etna). Simptomatologe: obra ti de engin cf pucmick S dspe! ul de veers amet een “alo sisalie>20 mle dst TA e on Sa Ra SSG ph nes ps foe Sento atoedaa emcee =n Asians terapeutied (5): 1 seinerpe rstmon siomtoogiy 4 Se splimeteaa aralgeia, ie pin splinentareaanestrch locale (ea conda st ma se depen dora ima de sole anes tere) ie se adminisueard salt, ‘+ pacientes ajezat In pore semiyezind, iar extrem eflic 1a 0" + adit de oxsen, 1 montrzare samme wise (TA pul) 4 hea tesnca as se ment aval side, s ai nisreaeh Coppi commpematede28 mg subingsal fsa instalings= Se rap (S10 mine); adminsncs sling ieipnel ep stePy pene ean de mad ed screaumareconmmanoscaie (oat detenioa sdeea brs a ‘Soni srterile, a hcue refed, chemie moc, sheie cere ‘alas ela, MOARTE SUBITA),Seutizez conform eemanaio ‘ctl ifr ee misres subinguaa yl compelmat de 28 mg Ee Cinta = Nitroglicering 1 comprima sublingual tu 1-2 put de eo sol sing 1 GuphSminste se eval tesane terials MMs vloaen leslie mormaizad se pote tena lies tran stmatologi, ach Se amcjpeu ea va de seu dua, ulterior ‘ocenl ind tnsporat nan sevice de Cae Silo su Medicines entry evar: Asch sloares tern se meine reset, 2 Hii Arsbulaa se admins Furosemid 9 fold 2040 mg) ims i + infect ch aloarea TA scade sau se meine la fel tiie, exe obligates tansprtl acest nie svi de Cardi Togi sas Medica nena pentru ctlure. CCORONAROPATILE (ve si sepunen Urges medial: Durr tor") Reunese un grup de afetun eae au In comun suena mo cams, conecateddevehibau dine Mux sanguin eorcaron ‘eve iced ‘Ip cbinetl de medic dentara pot taste umatarel ei le bli coraaiene ‘agin pectoral sais 1 ardopnteechemied nadueoas; 1 Sagoptie cu seury-pae, 1 nletmiocardie vee - ma at e 6 ln en produces, oar dpa roevaluarecadiolgic gt avie de specail (mse reco ‘mandi trea mal deveme de ln, deoatece il lel ete de ‘ron 4% a3 Kn de insane necooel mosaics ide 1S ate 6 an dup fan de niet, ta de morale se rece a 35). es rat 3s Condaita tn exbinetal de mein dentard in coronorapatile compensate eraperti: ‘consul arilogieefecwat eu maxima o un nin tr ‘amen tomatlogi; das is ast neva de tn a survenit modi Sidi le sisi generale piel, se epet carta eaoogis ‘ministre ira Inerupee meds de ri nclsv in zi imersenfelsomatalopc ca excepa miei! ancoaplate, care va fl modieatadapad dec medial cardnog, sb controll ‘coaguloiane).Adminisrares seid sctlsliie (Aspirin) = faverape pets 7 ile Inet I ete cdclglinerss consid posi, da find aciunea pens cae ot comand) ‘+ tulgeie opin: nage aninlamator asteroids ai sist per 0 imei, sine eu 30 minute de incepere tratment onatolope: + promaticaje ev analite de spl derivajilor de enzo zine (Midazolam comprinate $m pe 0, cu ¢ or site de ner vei) "+ ancsiezie loa de caltate;asoires de vaosonsticoae a substan aes In eonceneae de maximum 1:200 ODD se evi de (ite oes post {+ ttamentstomatooge tn poze semiezind, inca ins Sein cadice aoc, ‘acces apd la mali necerrh fn caval spiel un Sindom coronaria eu (Nitopicering Acid ae, ‘+ trammentl conc ev ancoaglane soy anagezante poste determina se cesut desing, de seen npn sa oc de emows ‘Sindroame coronariene:criza de angind pectoralé Simptomatoage: Angina pectoral reprint o fom lini anon! sche: mice, carci prin ezedueraseparoxitn, localize fet. Stem cae dure clive minutes dspar In aeinistace nor compat iti Nitoiceing). Atcu de dre rostral = orca* ne mec nega ade dent et anginoas pce in siti cae novia de oxigen a mica ese ‘a ar deste acoperis de Hux sanguin. lemenl craters ale dure anginotse sot worse + oclzr tpiehretoseal;aeor doen este precordial gastos, interseapuls indir a nde 9 mera pei, pila lime dou eget, uncon etre reganes corsa, mandbul, arcade dete (ia Aisle msn baton): 1 acai dreroash ace carver costs ste isis de vate; weet bln dese rere ca pe o seni de sur a0 {enconfor gre de dein ‘acces dures are de regu o dura e 3-8 minute; deen chutes raat, tinge un maxim, apo Sezafiadueroass Sees essa pre dup adminsvaea de Nivogierid, ‘+ neal eae era de angi pectoral exe sever, dee se pat isi de sinpiome asocate tanto: dpe, tans toe, geal (atte simpome aoa sper mal eve afc ‘migeardi act is rr in angina pectoral. _Aitudinea terapeate in crza de angind pectoral: fr enal aparige direst coronarene fn tpl tatamentl stomatolog,s vor apes ratoarl sin rapes: > iterugrea ttm stomaoogie agra psi ‘ulin pie semjezind cu piciouceprlle eu lanl orzo 2 eewee spare © pores sth moll de et fii svaaminia oxigenotapie (6 iin); ‘. slminisvare de Nioglicrnd sublingual, pla laws doze 4&0 mg nine de panna 5 minute; Nines cee pl Imioenie de oxigen prin dlsares vase eornaine pate i Seale Tem mecanie depus pin seadereprsacini (pein venti) ‘xhinsrres de Nile hui eva apace cx ree sei Sisoid see (100 rr st ell care ent spine lsd (ein de veri dept (repterea resol venelr pr, msc pulnonsa normals hptesite. + psotcpie anol, an on es * ack simplomaologia duerash persist pete 2030 minute pa instiier masurioe terspowtice de urgent se suspconears Inala wu! ifaret micardis. ‘Sindroame coronariene acute: infrctul miocardc acut (vt seciues: Uren mele: Duress tori") Sinptomatologie: Dyers reprint smpoml prinspal, vind cacti cu ea din crea angina, dar te de reguls mal severd da ma ‘mae, Tip, deren se ocean regiznen cena rac a srigasts 9 ocxal pt aa ud saptie pn le resis Oe il, dr coda na ada inferior de onic. Durer ete asea sf de ics, tania, ea vest fj anita see de ein, De dae a init seul, atu ete apt Inte rece se ct 3 Inuit paca in vrs ue infuse pote asta vu digoce ‘pia bral poate evolu se edem puna acct Rar, infil ioec cat Se poste manifsa prin pede ‘ruse a contin sire convo ari, sees Pt fsa stciie Obie amet pail cx supicae dif mi cx ate lo ote esr rp rc ‘peat ca spre spor val car infers pet ‘crapiei de repeeizie mincardic, ae Atitudinesterapetich fn suspicanen de infarct miocardie seat ig 6 *sobctaea Ambulat antigo, 4 ontinuaea aint de oxigen, so,” Moa ioe vie Geir nine ane ‘+ contol due Algoclnin Ketorolac, Tramadol; + acd suvine spel earn, se nara manevrle de resus tare pina ssi schipjspecaiat,esa de angind pectoral) ‘neenpes Foner emai comme tor par et 4 (seme ep et eet eee, (ire Omg ma cs aie (Sapewewa] Set — ete bil] Pee. INSUFICIENTA CARDIACA Insulin catiacd repent incapacaten miacandu de 3 Siz cele peice un volum sanguin sient, enone case tere ma motion fei eatioe, ele mal eevee ind HTA gh ‘la cororrian| “Taamente tomstolopice simple, de curt art, ep feta Inambulaor a can tonaor eu sufieg adc compensth ‘Conduit fn cablnetl de meicing dear + consult cadaiogi ect fnsnten tater stom ogi cu maximum | Tank; ded fn oes inerval de tin au srvenit modified ale sti generale epacenul, se repet const ear Toni: 4+ adoisineares is ntespere a mois de aid inhi In siua intervened somstologie (or excep medical sticoagante, sare va fi modiistadopa de cate medical eadolg, sub cont fougulograms).Adminisvares.acidlut acetic (Aspiring) 36 Tnerapepereu 7 lel elf ate crdologulinrnisu conde sii dat ind afejinea pent cae a fost recarsandat) ‘+. reducer descr de cueolamine endogene, pin anal= eve bun i peemedicaje seats (Midaolam pros 7 ta). = nu se flosesecoecivi vasoconsritr fn azul boar ial ised ular de i gre), ‘= ttimentlsomatlope se va practic c blnaal in pozite semigezind, ‘+ proflna endocanisi bactriene, dah exist valli €Edemul pulmonar acut (vis sectnes Unsafe mele: Edema pulmonar act) Ee pen medicals major, itaventia prompts yi corset & ‘mola pt san vn pcr, "Edel pulmonar st (EPA) rprezint uy sndrm line po sede de reeset deli in spl extravasclare ale pire Simptomatologie: 1 "disgace pass polipnee ox ortopce + spiaiefomnolent 4 tegument pide, vanspiai e,cianoies expec seoss, rr, tabi; joule irgescente;* Luger mse eters eres dai + saucubai: rr soberepitate ister 1 ipotnsan, claps Atitudineaterapeatcd in eabinetal de meivind dentar EPA Gh 7 emul pulmonar seut is acres te Homage | [eames aamare seein ea ah we Een | Se eta Anuar + nteiperes tne stomaolgie gi ager pase ‘uli ea tani in poze vercalé si membre infiare InP ‘eto gonna rate prescin) +" spiren expect si curtiaen viii ore st a ote ine oft “ 1 oxigenotrapi (46 Ui + rduverea presacini pin apie prolimangte ‘essometrll Ia nivel memivelor, cin rotaie (ls 5-10 mint) (flebotomia inchisa"), manevea este conta act TAs ese “100 ‘mfg, panei la vrs ce teroceroad cerebral (se de AVC Ischemiy 1 montrzaeserne vite (TALpus A acd TAs «100 mn: se sole Ambulana ant-soc si daca 7A, >100 mate + administarea ix. aun duro eu acjune mpi Furosemid2 fle tip de -3 nue ‘+ administra de vasodiltatare per reducer presale vasculie Sistemice pulmonar: Nitoglieinh 12, comptimae Soblingua pt (nu sadn ch TAs <100 malt) In caz de eae vagal virtua) se esocaes Avopioa I mgiim. ‘TULBURARILE DE RITM CARDIAC (ea senna Urgene mace: Turi de rim de conducere") Armies expresa uni cadopapeeitene, ptind inflaeyaevolgianegtv, earls acs dar pot apica 9 a Pen sino Tratmniele stomsologice se vor despa obligatory in ond de spitalzare in sie de chirgle oni la ps lea eu bri de itm nb * ohicarde passes sopravenroula, baat pont su ie ai 4 tuheadie vencula sau Ghiafe vesicular inant eden! “bloc atro-emtiul tl (i pacemaker ‘ua de nod sinus (ra pera,‘Condit in cainetal de modiing dena: "Tonk erolgi faut Ines tates sonst- loi, cu sium ofa aso cst trl de np a seni ‘mois ales genre's pace pelt cost eu loge inves fs ietocpte & medi d tin inv ‘nua teens somnlogie Gu scepa dpe songs, tur va f modlcatadapath de ee nade carole, conta Sevgalograma).Adminraca cdl estate (Asp) innenpe pet 7 cle ll ce catologintenislo conser posi da Hind lone peta car fot ecrandt) oars sone vil pl, TA) terprzre iaere fei sommlope dct vena carta exe>12m, = m8 9 ‘Ssomandars une raf ceils. trodes dee de xcoiine endogns, in ag sci bo pomaesesedta(Miszalam er or 75 ou flee ere ake pce gaia (se deine er 2 pail poor de paesmsker cate: vebieeviate inereeiecanguror semagntc (eiromoor cet, apart rors co dy lector tpl, ese neces bq VALVULOPATIE Lesunile valvlare ernie reins 9 tologe ives cel mal ficeventreumatismalt. De repulf,pacenit eu feeGunt valvular i) ‘nose dgnostel, dar exis sua in ear pci relent dost ‘vista unr sua cardiac, element care tbe pnt suspen ‘ne valvlopai, eesti realizar uns cons de specie Valelopatie ae asia cu scl umor complica ce ot inofse totanentalstomatologe ‘ria (exter ine rat “2 = declnjrea ue crv de ann ptr instalarea ue! str sinsople in senor sot rind), * edocaita aceind Conduit in cabinet de meaicing deta + consult crop eect ines tamu sor Topi, cu masimum o uns des in cet intr de inp au seni ‘mole’ sle stiri generale a pasenus, se rpet costal car tol; : *_admiistare fia tierapee a mediate! de rating, ncasiv in siu intervene stomatologice (eu excepin meds anticong lane). Adminisarea adult actlsaliiie (Aspirna) se intepe er 7 ile Gino de isterveni) ao lace carlogsiemisalo| ‘considera posi, da ind afeciuea pet cae a fot comand! + amibiopoixin ndocardis buteene. TRATAMENTUL CRONIC CU ANTICOAGULANTE ORALE (ACO) Tratamentul anicogalint oral exe indicat petra preveniea fonmasi de roi amv coral saa vaso sang Cele mai feeventeafeeun sistmice in cae ete neces re ‘srentlamicongulaa dela dah nt ia ald ric 9 ‘tombora venoas profunda (oid sau ma cu embolle pulmonar} ‘Amine conics de antcogulane est ino nto sre de alte ‘tani inf mead cts eurent, by-pass vacuo val ulate, post AVG, sindrom ett, sindromal antonio anticado. Upinii Medica anicosglanis oral este repezntatt de derivti cumini» antgonigi a vitamins K: Warfarin 1 Aecrocimaol (Trombostop, Snrom). ect trapeuic Aeeostmaolll spare in 2436 oe este maxi tn 48-72 oe. Timpul de injumstie ested S- hoe,“ 0 cl tS ms dt Motz tant ACO se liens pn detrinrea pero a INR hereon Neale Rat) un por sndadat {ncaa it slaea TP (np de prtmbing) pase TP Gimgal de promt) tar “Trumencle somisogce 20 vor deslca obligatory in condi de piven sie de ching oromnsio ils ‘sri nai ere gern de rss ou exit posite ci et targets ACO [aes intervenfii singerinde programate, daci este necesari sub- sttjaco heparin snd, dont pe inca pio de renee mec). Condit in cabinet de mediing dena "mt calle eet nies fame ton loi, co main Ted, Sh in se neal de tng a0 vent Indic ale si genrle a pa nope cou cae Silos ery ‘firs intrerupere a medicapiei de rutin’, inclusiv sins incre somilogce (or expe meet atooge tan + dacs mesic cadiolog soma ineropere tare savicoagulat ort qi soba cu hepariod acon (Cleune Feaxparne, mole 1. se trap ednstaea ACO; 2 ae adminiteseheparins fracoost cep cua tron interpert ACO; 4. se monitoizaet INR ine nd INR angel valor “Sat se pote elect interven stomatloich singe rind, 4 Reptina faction se tnreape eu 12 or inte Intervene eae 12 ore dap aes: 5. se retodace ia tatament anicoagulanl or sind riseuile hemoragce sum dept, concomient cu a Ininisrrea de epi acon nee rah « 6, se imrerape hepsi fractional ind tpl Howell (eu ‘are se umaete atte anticoagulant a heparsels) ajunge vals 223 oni la doud reco ice ‘+ extamentalantapresant plisbetr (acid setae! Aspirin ssn Pla) - se va ere avn etsy peoogul| ines care nip terapa (ghd sunt int coin schim uel, 1+ seimpune ohemostz chinrgicalt minis 4 dat este necesars administrate dealpetce, se recomands ele care mu iti agrearen plachutar (Paracetamol, ilbtoare oxy ‘se contanditadiniteare preiralsntramuseua (ise eheratoa) act piel delart cb ume un trtaneat tcoagulant oar dup efctares une intveni somatlogce sien, se con ‘elec cals hamostzlecale se wine pint nun serie speciiat de Caliologi sade Mein inert. PROFILAXIA ENDOCARDITEI INFECTIOASE (conform american Heart Assocation/2007), Endocarita bacterin rprezint o bold infos grva cre spre fno sere deaftincartacecangenileJbinait, i spoil in cele In care se produe nur sanguine cv veloc ric care determing ecu endecilece preispanIafrmarea uno dooce de ‘lachete flint Aces ane pein un ie mare de econ es fete sepice in cusul basuriemie ct vise de cleo, moro Finejonae ese sau emboli sites Profilin endocarieinefoae const tn administered antic nunca erie interven invasive cae pote deterina tacteemie Th farce de afeyunea cari, rc de endo nici pref majo, modu sau segliabl, ines pera antbioponiefind subi in ite de acest rise, Aceste else des a fos sine rate de AIT. ‘Recomandiile AHA. penta prvenivn cadceare! infos revisit inal 2007 oncuronsat cd pie au av vei un iti ‘in adminisearca unl anbite In soap proictic, im cal nor interven nivel tact dies sa pvt Tong pnt Ia acest onent, Socetea Europeans de Car iologiepsteach in pial popriyndeaile de poflaie pera Intervene stomatologice ce comport un anumi ead een ec sre endocadite infefons, “Coniile ptlogicessociate care eres rise aah eno cant info snt prez fn tabelal ur (bell a oe ska rx moj Prien nc Mnlom fecal | arma aie cece 1 mene comple ei ine prema ccc coin ert omen fissile | bo hn cabinet de mediind dentrt se rcomands efectuarea Je inceeni singeriade dora pcieni ew ise ea Prosduri somminlogie singerinde cae indict instiues proflaveendocaitsinfecoase int coprinse in abel mato (bell; dius a 2 Tees ange A Sineveri sualeSemis Y= Sapte Tea nose 1 tain tt empor Scheme tropic de anibaprofnie inate de cre Ata i 1, Regia andar: Amoi 23g or oo sine deinen Regal leone: sadn fe stn cn post coma a imi ltl, eatin lad pre /hipersensibilitate la beta-lactamine: rs Clinic: mg rl cu In de nerve; 2 Cefcotn 2 5 orl eu 0 ort ante deiner ied ergata perce rv es Se lp tea, eon Cavin 500 mg ooo nine de inert: Diss au se piste rela adninsea pe cle old se sscomandt adminis de Amst pv satin) eu 30 mae ‘nine de interven: Dec pore pein al slain, Se or ulin fe Cialis 600 mp Iv ct 0 mina Tine 0 Ince, fe Cling 1 i.e 30 mint iano inereae (dc lero ete de ip na that si evr oct dz din prep aint uo oe imine deiner ore Sen