DODT411-CARDIOVASCULAR DISEASES

CARDIOVASCULAR DISEASES
➢ broad term used to describe a range
of diseases affecting the heart and Etiology:
the blood vessels ● PRIMARY HYPERTENSION
○ ESSENTIAL or IDIOPATHIC
HTN
○ Accounts for 90-95% of
cases
○ Genetic link
○ No clearly established
genetic pattern has been
established for PRIMARY
HTN. However, blood
pressure levels appear to
have strong familial
Types of Cardiovascular Diseases tendencies.
A. Hypertension
B. Bacterial Endocarditis ● SECONDARY HYPERTENSION
C. Congestive Heart Failure ○ Accounts for 5-10% of cases
D. Angina Pectoris ○ There is an underlying
E. Myocardial Infarction systemic disease that
produces hypertension as a
HYPERTENSION secondary complication.
➢ defined as a sustained elevation of ○ These conditions include
the diastolic pressure that results renal disease, endocrine
from increased peripheral arteriolar disorders and neurogenic
resistance problems.
➢ an abnormal elevation of arterial
pressure that can be fatal if ● ISOLATED SYSTOLIC
sustained and untreated HYPERTENSION
➢ it is the symptomatic manifestation ○ A specific form of
of an abnormal state of circulation hypertension most commonly
found in elderly individuals
Category Systolic (mmHg) Diastolic (7th decade)
(mmHg)
○ Systolic blood pressure of
Normal <130 <85 >140 mmHg
High Normal 130-139 85-89
○ Diastolic blood pressure of <
90 mmHg
Hypertension
○ ETIOLOGY: decreased aortic
Stage 1 (mild) 140-159 90-99 distensibility (elasticity)
Stage 2 (moderate) 160-179 100-109
secondary to aortic
arteriosclerosis.
Stage 3 (severe) 180-209 110-119

Stage 4 (very severe) >210 >120

 ● patient may not display its symptoms
for a long time but could experience
damage with resultant symptoms in
several organs :kidneys, brain and
eyes
● not usually discovered by the dentist
during clinical examination but is
generally found by inquiry during
history taking
● when the dentist determines the BP,
must evaluate his findings in terms
of N for that particular individual
● when the patient offers the
information that he has high BP,
must evaluate the information in
terms of signs and symptoms of high
BP.
● though BP may be recorded in the
dental office, the interpretation of the
findings requires experience and
knowledge outside the general
practice of dentistry.
● history alone may present sufficient
evidence that may warrant referral to
a physician for a more complete
evaluation
Signs and Symptoms:
● occipital headache
● dizziness
● tingling of the hands and feet
● weakness
● angina pectoris
● ringing of the ears
Only the physician diagnoses HPN and
makes decisions on its treatment. Dentist
must make determinations of abnormal
readings which become the basis for
physician referral
BP MEASUREMENT
A. Systolic pressure
➢ pressure at the peak of
ventricular contraction
B. Diastolic pressure
➢ represents the total resting
resistance in the arterial
system after passage of the
pulsating force produced by
contraction of the L ventricle
Potential Problems to Dental Care
1. Stress and anxiety may cause an
increase in BP, angina, MI, CeVD.
2. Patients being treated for
hypertension may become
nauseated or may develop
orthostatic hypotension
3. Excessive use of vasopressors may
cause significant elevation of BP
4. Sedative medications used in certain
hypertensive drugs may bring about
hypotensive episodes
MANAGEMENT CONSIDERATIONS
HPNsive patients pose some significant
management considerations which include:
● identification
● monitoring
● stress and anxiety reduction
● prevention of drug interactions
● awareness and management of drug
effects
● management of drug effects on the
tissues

Identification:
● the only sign of trouble may be an
elevated BP
● high risk groups: obese individual,
blood relatives of HPNsive patients
● dentist should not make the
diagnosis of HPN but should inform
the patient who has an elevated BP
that its numeric value is abnormal
and that a physician should evaluate
the condition
● medical history – family history,
identification of risk factors ,
associated disorders and history of
known HPN and treatment
STRESS AND ANXIETY REDUCTION
● establish a rapport with the patient
● patient should be encouraged to
○ express himself
○ discuss his fears and
concerns
○ ask question about dental
treatment
● premedicate with a SA
benzodiazepine
○ 1 dose at bedtime and 1 hour
before the dental
appointment
● long and stressful appointments are
avoided
○ if appointment becomes
stressful terminate and
reschedule
● use of LA : 1-2 cartridges of 2%
lidocaine with 1:100,000 epi
Prevention of Problems
Patients being treated with anti- HPNsives ,
the following procedures may be used:
a. Reduce stress and anxiety by giving
premedication, short appointments,
and open, concerned atmosphere by
the dentist and his staff.
b. If patient becomes overly stressed,
terminate appointment
c. Avoid orthostatic hypotension by
changing chair position slowly and
supporting patient when getting up
from chair
d. Avoid stimulating gag reflex
Prevention of Drug Interaction
● some anti-HPNsive drugs can
predispose patients to orthostatic
hypotension and potentiate action of
barbiturates and other sedatives –
dosage should be reduced
● anti-HPNsive drugs and NSAIDS:
decrease the activity of
antiHPNsives with prolonged use of
NSAIDS
Diuretics - thiazides – reduce plasma
volume and extracellular fluid by inc
excretion of Na
➔ dry mouth and lichenoid reactions
ex. Furosemide (Lasix)
Spironolactone (Aldactone)
Beta-adrenergic blockers – block b.a.
receptor sites.
➔ altered taste and lichenoid rxns
ex. Propanolol (Inderal)
Metoprolol
Ca channel blockers - inhibit Ca ion influx
into cardiac and vascular smooth muscles
➔ gingival hyperplasia
➔ dry mouth
ex. Nifedipine (Calcibloc)
Amlodipine (Norvasc)
Drug Consideration

1. Use LA judiciously with minimal

concentration of vasopressor;
aspirate before injection and inject
slowly
2. Reduce dosage of barbiturates and
other sedatives whose actions may
be enhanced by anti-hypertensive
drugs

Treatment Planning Modification

1. For patients under good medical

management with no complications ,
such as renal failure, any indicated
treatment may be provided
2. For patients with complications, refer
to physician