CARDIOVASCULAR DISEASE AND HYPERTENSION

Group 2

 Cardiovascular disease is the class of diseases that involve the heart or blood vessels (arteries and veins). refers to any disease that affects the cardiovascular system used to refer to those related to atherosclerosis (arterial disease) quite common, though more frequent and severe in later life, can also affect young individuals one of the leading cause of death in the world

Symptoms
Chest pain - common presentation of cardiac diseases Breathlessness or dyspnea -major symptom of many cardiac disorders, particularly left heart failure

3 Forms of Dyspnea
Orthopnea - lying flat causes a steep rise in left atrial pressure in patients with heart failure resulting in pulmonary congestion and severe dyspnea. A semi recumbent position helps such patients. Paroxysmal nocturnal dyspnea - Frank pulmonary edema on lying flat awakes the patient from sleep with distressing dyspnea. Symptoms are corrected by standing upright. Exertional dyspnea - exercise causes a sharp increase in left pressure resulting in dyspnea.

Fatigue Palpitation Dizziness and syncope Lower limb pain or discomfort Edema of legs

Clues that suggest the presence of cardiovascular disease

Cyanosis Finger clubbing Distended neck veins Swelling of legs due to peripheral edema Blood pressure Pulse rate and rhythm

Common cardiovascular disorders

Hypertension Ischemic or coronary heart disease Myocardial infarction Congenital heart disease Rheumatic fever Infective (bacterial) endocarditis Heart failure

Heart Failure & rheumatic heart disease

Cuala,juliet m.

Heart Failure
Is also called congestive heart failure Is a condition in which the heart can no longer pump enough blood to the rest of the body. Is a serious disorder. It is usually a chronic illness, which may get worse with infection or other physical stress.

Causes, incidence, and risk factors

Heart failure is almost always a chronic, longterm condition, although it can sometimes develop suddenly. The condition may affect the right side, the left side, or both sides of the heart.

 Right-sided heart failure means the right ventricle of the heart loses its pumping function. Left-sided heart failure means the heart's ability to pump blood forward from the left side of the heart is decreased. The left side of the heart normally receives blood rich in oxygen from the lungs and pumps it to the remainder of the body.

Heart failure is often classified as either systolic or diastolic.

Systolic heart failure means that your heart muscle cannot pump, or eject, the blood out of the heart very well. Diastolic heart failure means that your heart's pumping chamber does not fill up with blood.

The most common cause of heart failure is coronary artery disease, a narrowing of the small blood vessels that supply blood and oxygen to the heart.
Heart failure can also occur when an illness or toxin weakens the heart muscle or changes the heart muscle structure. Such events are called cardiomyopathies.

Other heart problems that may cause heart failure are:

Congenital heart disease Heart valve disease Some types of abnormal heart rhythms (arrhythmias) Diseases such as emphysema, severe anemia, hyperthyroidism, orhypothyroidism, may cause or contribute to heart failure

Symptoms
Common symptoms are: Shortness of breath with activity, or after lying down for a while Cough Swelling of feet and ankles Swelling of the abdomen Weight gain Irregular or rapid pulse Sensation of feeling the heart beat (palpitations) Difficulty sleeping Fatigue, weakness, faintness Loss of appetite, indigestion

Other symptoms may include: Decreased alertness or concentration Decreased urine production Nausea and vomiting Need to urinate at night

Some patients with heart failure have no symptoms. In these people, the symptoms may develop only with these conditions: Anemia Hyperthyroidism Infections with high fever Kidney disease Abnormal heart rhythm (arrhythmias)

Signs and tests

A physical examination may reveal the following: Fluid around the lungs (pleural effusion) Irregular heartbeat Leg swelling (edema) Neck veins that stick out (are distended) Swelling of the liver

 Listening to the chest with a stethoscope may reveal lung crackles or abnormal heart sounds. The following tests may reveal heart swelling, decreased heart function, or lung congestion: Chest x-ray ECG Echocardiogram Cardiac stress tests Heart CT scan Heart catheterization MRI of the heart Nuclear heart scans

 This disease may also alter the following test results: Blood chemistry Complete blood count Liver function tests Uric acid -blood test Sodium - blood test Urinalysis Sodium - urine test

Treatment
If you have heart failure, your doctor will monitor you closely. You will have follow up appointments at least every 3 to 6 months and tests to check your heart function. You will need to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that your heart failure is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.

Severe heart failure may require the following treatments:

Intra-aortic balloon pump (IABP), a temporary device placed into the aorta Left ventricular assist device (LVAD), which takes over the role of the heart by pumping blood from the heart into the aorta; it's most often used by those who are waiting for a heart transplant. Note: These devices can be lifesaving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.

Prevention
Take your medications as directed. Carry a list of medications with you wherever you go. Limit salt intake. Dont smoke. Stay active. For example, walk or ride a stationary bicycle. Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.

Rheumatic Heart Disease

the most dreaded complication of rheumatic fever refers to the chronic heart valve damage that can occur after a person has had an episode of acute rheumatic fever. This valve damage can eventually lead to heart failure.

 Acute rheumatic fever often produces inflammation of the heart (carditis). This carditis affects virtually all parts of the heart - the pericardial, or exterior, surface of the heart (pericarditis); the heart muscle itself (myocarditis); and the endocardial, or interior, surface of the heart (endocarditis).

 Rheumatic heart disease ends up affecting about half the people who have rheumatic fever with carditis. Most of the time, rheumatic heart disease is diagnosed 10 to 20 years after being "triggered" by acute rheumatic fever.

Treatment
Once a person has had rheumatic fever, especially if it has caused carditis, it is critically important to prevent any more episodes of rheumatic fever. So anyone who has had rheumatic fever should be on preventative, or prophylactic, therapy with antibiotics to prevent a recurrence.

 Anyone who had acute rheumatic fever should have a physical examination annually to see if any change has occurred in the heart. A new heart murmur or a change in a previous heart murmur might indicate that heart valve damage has begun. An echocardiogram would confirm the presence or absence of heart valve damage.

CEREBROVASCULAR DISEASE (STROKE)

KENNETH CRUZ

 previously known medically as a cerebrovascular accident (CVA) is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood).

As a result, the affected area of the brain is unable to function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.

 A stroke is a medical emergency and can cause permanent neurological damage, complications, and death. It is the leading cause of adult disability in the United States and Europe and the second leading cause of death worldwide.

Risk factors
old age, hypertension (high blood pressure), previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking and atrial fibrillation. High blood pressure is the most important modifiable risk factor of stroke.

CLASSIFICATION: In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area. There are four reasons why this might happen:
1. Thrombosis (obstruction of a blood vessel by a blood clot forming locally) 2. Embolism (obstruction due to an embolus from elsewhere in the body, see below), 3. Systemic hypo perfusion (general decrease in blood supply, e.g., in shock) 4. Venous thrombosis

HEMORRHAGIC Intracranial hemorrhage is the accumulation of blood anywhere within the skull vault. A distinction is made between intra-axial hemorrhage (blood inside the brain) and extra-axial hemorrhage (blood inside the skull but outside the brain). Intra-axial hemorrhage is due to intraparenchymal hemorrhage or intraventricular hemorrhage (blood in the ventricular system).

Main types of extra-axial hemorrhage

epidural hematoma (bleeding between the dura mater and the skull) subdural hematoma (in the subdural space) subarachnoid hemorrhage (between the arachnoid mater and pia mater). Most of the hemorrhagic stroke syndromes have specific symptoms (e.g., headache, previous head injury).

ISCHEMIC HEART DISEASE

Cherryl bagaporo

 Ischaemic or ischemic heart disease (IHD), or myocardial ischemia, is a disease characterized by ischemia (reduced blood supply) of the heart muscle, usually due to coronary artery disease (atherosclerosis of the coronary arteries). Its risk increases with age, smoking, hypercholesterolemia (high cholesterol levels), diabetes, and hypertension (high blood pressure), and is more common in men and those who have close relatives with ischaemic heart disease.

 Symptoms of stable ischaemic heart disease include angina (characteristic chest pain on exertion) and decreased exercise tolerance. Unstable IHD presents itself as chest pain or other symptoms at rest, or rapidly worsening angina. Diagnosis of IHD is with an electrocardiogram, blood tests (cardiac markers), cardiac stress testing or a coronary angiogram. Depending on the symptoms and risk, treatment may be with medication, percutaneous coronary intervention (angioplasty) or coronary artery bypass surgery (CABG).

 It is the most common cause of death in most Western countries, and a major cause of hospital admissions. There is limited evidence for population screening, but prevention (with a healthy diet and sometimes medication for diabetes, cholesterol and high blood pressure) is used both to prevent IHD and to decrease the risk of complications.

 The medical history distinguishes between various alternative causes for chest pain (such as dyspepsia, musculoskeletal pain, pulmonary embolism). As part of an assessment of the three main presentations of IHD, risk factors are addressed. These are the main causes of atherosclerosis (the disease process underlying IHD): age, male sex, hyperlipidaemia (high cholesterol and high fats in the blood), smoking, hypertension (high blood pressure), diabetes, and the family history

SIGNS AND SYMPTOMS

Ischaemic heart disease may be present with any of the following problems: Angina pectoris (chest pain on exertion, in cold weather or emotional situations) Acute chest pain: acute coronary syndrome, unstable angina or myocardial infarction ("heart attack", severe chest pain unrelieved by rest associated with evidence of acute heart damage) Heart failure (difficulty in breathing or swelling of the extremities due to weakness of the heart muscle)

 The medical history distinguishes between various alternative causes for chest pain (such as dyspepsia, musculoskeletal pain, pulmonary embolism). Main causes of atherosclerosis (the disease process underlying IHD): age, male sex, hyperlipidaemia (high cholesterol and high fats in the blood), smoking, hypertension (high blood pressure), diabetes, and the family history

DIAGNOSIS The diagnosis of ischaemic heart disease underlying particular symptoms depends largely on the nature of the symptoms.
The first investigation is an electrocardiogram (ECG/EKG), both for "stable" angina and acute coronary syndrome. An X-ray of the chest and blood tests may be performed. Myeloperoxidase has been proposed as a biomarker.

PREVENTION Various treatments are offered in people deemed to be at high risk of coronary artery disease. These include control of cholesterol levels in those with known high cholesterol, smoking cessation, and control of high blood pressure.

MANAGEMENT In stable IHD, antianginal drugs may be used to reduce the rate of occurrence and severity of angina attacks. Treatments for acute coronary syndrome and established coronary artery disease are discussed above in "diagnosis". Revascularization for acute coronary syndrome has a significant mortality benefit .Recent evidence suggests that revascularization for stable ischaemic heart disease may also confer a mortality benefit over medical therapy alone.

CONGENITAL HEART DISEASE

 a type of defect or malformation in one or more structures of the heart or blood vessels that occur before birth .These defects occur while the fetus is developing in the uterus and affect 8-10 out of every 1,000 children. may produce symptoms at birth, during childhood, and sometimes not until adulthood. About 500,000 adults in the U.S. have congenital heart disease. In the majority of people; the cause of congenital heart disease is unknown. However, there are some factors that are associated with an increased chance of getting congenital heart disease. These risk factors include: Genetic or chromosomal abnormalities in the child such as Down syndrome. The risk of having a child with congenital heart disease is higher if a parent or a sibling has a congenital heart defect -the risk increases from eight in 1,000 to 16 in 1,000.

Types of Congenital Heart Problems

Heart valve defects. Narrowing or stenosis of the valves or complete closure that impedes or prevents forward blood flow. Defects in the walls between the atria and ventricles of the heart (atrial and ventricular septal defects). These defects allow abnormal mixing of oxygenated and unoxygenated blood between the right and left sides of the heart. Heart muscle abnormalities that can lead to heart failure.

Symptoms
Congenital heart disease may be diagnosed before birth, right after birth, during childhood, or not until adulthood. It is possible to have a defect and no symptoms at all. In adults, if symptoms are present, they may include: Shortness of breath. Limited ability to exercise.

Diagnosis
Congenital heart disease is often first detected when your doctor hears an abnormal heart sound or heart murmur when listening to your heart. Depending on the type of murmur your doctor hears, he or she may order further testing such as: Echocardiogram or transesophageal echocardiogram (TEE) Cardiac catheterization Chest X-ray Electrocardiogram (ECG or EKG) MRI

Treatment
Treatment is based on the severity of the congenital heart disease. Some mild heart defects do not require any treatment. Others can be treated with medications, procedures, or surgery. Most adults with congenital heart disease should be monitored by a heart specialist and take precautions to prevent endocarditis (a serious infection of the heart valves) throughout their life.

PERIPHERAL VASCULAR DISEASE

 commonly referred to as peripheral arterial disease (PAD) or peripheral artery occlusive disease (PAOD), refers to the obstruction of large arteries not within the coronary, aortic arch vasculature, or brain. can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism, or thrombus formation. It causes either acute or chronic ischemia (lack of blood supply). PAD is a term used to refer to atherosclerotic blockages found in the lower extremity.

Classification
A more recent classification by Rutherford consists of three grades and six categories. Mild claudication, Moderate claudication Severe claudication, Ischemic pain at rest Minor tissue loss, Major tissue loss

 mild pain when walking (claudication), incomplete blood vessel obstruction; severe pain when walking relatively short distances (intermittent claudication), pain triggered by walking "after a distance of >150 m in stage IIa and after <150 m in stage II-b"; pain while resting (rest pain), mostly in the feet, increasing when the limb is raised; biological tissue loss (gangrene) and difficulty walking.

Symptoms About 20% of patients with mild PAD may be asymptomatic; other symptoms include: Claudication - pain, weakness, numbness, or cramping in muscles due to decreased blood flow Sores, wounds, or ulcers that heal slowly or not at all Noticeable change in color (blueness or paleness) or temperature (coolness) when compared to the other limb (termed unilateral dependent rubor; when both limbs are affected this is termed bilateral dependent rubor) Diminished hair and nail growth on affected limb and digits.

Causes
Risk factors contributing to PAD are the same as those for atherosclerosis. Smoking - tobacco use in any form is the single most important modifiable cause of PVD internationally. Smokers have up to a tenfold increase in relative risk for PVD in a dose-related effect. Diabetes mellitus - causes between two and four times increased risk of PVD by causing endothelial and smooth muscle cell dysfunction in peripheral arteries.

Treatment
Dependent on the severity of the disease, the following steps can be taken: Smoking cessation (cigarettes promote PVD and are a risk factor for cardiovascular disease). Management of diabetes. Management of hypertension. Management of cholesterol, and medication with antiplatelet drugs. Medication with aspirin, clopidogrel and statins, which reduce clot formation and cholesterol levels, respectively, can help with disease progression and address the other cardiovascular risks that the patient is likely to have. Cilostazol or pentoxifylline treatment to relieve symptoms of claudication.

Hypertension

 Because it often has no symptoms, hypertension is many times referred to as the silent killer. Health-care providers always remind us that the only way to truly detect if you have high blood pressure is to have your blood pressure checked regularly. This means the truest indicator of all of the symptoms of hypertension is when the doctor tells you have high blood pressure. One of the leading causes of an elevation in blood pressure is obesity. So, even without experiencing any of the signs of hypertension or feeling any of its ill effects, if obesity is a factor in ones life, this person should be especially careful to monitor his or her blood pressure. However, now and then a person who has previously not been diagnosed with hypertension and may not have obesity as a factor may experience one of the known symptoms. These symptoms can vary greatly in intensity, and often people who don't have any elevation in blood pressure whatsoever can experience these same effects of hypertension.

 Headaches Most people have experienced headaches from time to time. Usually, these are referred to as tension headaches. However, it is possible to experience a headache as one of the effects of hypertension. Of course, a simple tension headache does not immediately indicate the need to quickly lower ones blood pressure but it does signal the need to get it checked.

 Nosebleeds Having nosebleeds for no apparent reason can be an indication a person's blood pressure has gotten higher for one reason or another. Of course, a person who just got hit in the nose may well have a nosebleed without an accompaniment of hypertension. pressure checked. Surely, a nosebleed is a possible side effect of high blood pressure.

 Blurred Vision
Changes in vision, for instance, blurred vision can also be a sign of high blood pressure. Suddenly having blurred vision can also be a side effect of some medications, as well. If a person's vision becomes blurred it should be checked out very quickly. In some cases, this may mean your doctor will try to quickly lower your blood pressure.

 Dizziness is one of the more common complaints from people whose blood pressure is high. Once again, there could be many reasons why a person may become dizzy. In fact, even low blood pressure can be accompanied by dizziness. Another common reason for dizziness would be an inner ear infection. Nonetheless, no one should fool around with dizziness. It would be wise, if experiencing dizziness, to see a health-care provider.

 Tinnitus Ringing in the ear, which is also known as tinnitus, is seen as one of the symptoms of hypertension. Many people have tinnitus for years and have no real serious underlying problem. On the other hand, there are a host of reasons a person could be experiencing tinnitus. So the wise thing here is to simply get it checked out.

 Quickly Lower Blood Pressure Without having an extreme situation, your doctor can prescribe a medication that will help to lower your blood pressure quickly. Also, there are things a person can do to help the doctor's prescription along.

High Blood Pressure Overview

The heart pumps blood into the arteries with enough force to push blood to the far reaches of each organ from the top of the head to the bottom of the feet. Blood pressure can be defined as the pressure of blood on the walls of the arteries as it circulates through the body. Blood pressure is highest as its leaves the heart through the aorta and gradually decreases as it enters smaller and smaller blood vessels (arteries, arterioles, and capillaries).

How is blood pressure measured? Blood pressure is measured with a blood pressure cuff and recorded as two numbers, for example, 120/80 mm Hg (millimeters of mercury). Blood pressure measurements are usually taken at the upper arm over the brachial artery. The top, larger number is called the systolic pressure. This measures the pressure generated when the heart contracts (pumps). It reflects the pressure of the blood against arterial walls. The bottom, smaller number is called the diastolic pressure. This reflects the pressure in the arteries while the heart is filling and resting between heartbeats.

The American Heart Association has recommended guidelines to define normal and high blood pressure. Normal blood pressure less than 120/80 Pre-hypertension 120-139/ 80-89 High blood pressure (stage 1) 140-159/90-99 High blood pressure (stage 2) higher than 160/100 As many as 60 million Americans have high blood pressure. Uncontrolled high blood pressure may be responsible for many cases of death and disability resulting from heart attack, stroke, and kidney failure.

DENTAL MANAGEMENT OF PATIENTS WITH CARDIOVASCULAR DISEASE AND HYPERTENSION

 The primary management goal for the patient with cardiovascular disease during dental therapy is to ensure that any hemodynamic change produced by dental treatment does not exceed the cardiovascular reserve of the patient. This is best achieved by minimizing any hemodynamic alterations during treatment (that is, by maintaining the patients optimum blood pressure, heart rate, heart rhythm, cardiac output and myocardial oxygen demand).

 shorter appointments, preferably in the morning when the patient is well-rested and has a greater physical reserve; use of profound local anesthesia to minimize discomfort; preoperative or intraoperative conscious sedation or both; excellent postoperative analgesia.

A. Local Anesthesia
Dental patients with hypertension are best treated under local anesthesia being sure that the anesthesia is complete so that no anxiety induced elevation of blood pressure occurs. The use of vasoconstrictors such as epinephrine in local anesthetic agents is known to have negligible influences on blood pressure in hypertensive patients, according to numerous clinical studies.

 The use of aspirating syringes in local anesthetics is imperative to avoid intravenous, intrarterial, intraligamentary and intrabony injections, which could potentially precipitate further anxiety and thus rise in pressure and possible arrhythmias.

B. General Anesthesia
All antihypertensive drugs are potentiated by general anesthetic agents, especially barbiturates. General anesthesia tends to cause vasodilation. A severely reduced blood supply to vital organs can be dangerous in healthy individuals, but in the hypertensive person with vascular disease there is greater risk as the tissues have become adapted to a raised blood pressure which is needed to overcome the resistance of the vessels and maintain adequate perfusion.

ANXIETY CONTROL
The anxiety and stress associated with dental treatment typically causes a rise in blood pressure and may precipitate cardiac arrest or a cerebrovascular accident. Preoperative reassurance and oral sedation may help in alleviating anxiety related rise in pressure. Use of sedatives the night before a procedure may also be used.

TIMING OF DENTAL APPOINTMENTS

The increase of blood pressure in hypertensive patient is associated with the hours surrounding awakening that peaks by midmorning. This fluctuation of blood pressure tends to be less likely in the afternoon. Afternoon appointments are recommended over mornings for this reason.

OTHER DENTAL CONCERNS

Aspirin is now commonly taken by patients with hypertension to decrease associated coronary or cerebral vascular thrombotic disease, and aspirin may cause bleeding problems. Many patients with hypertension develop systolic heart murmurs, in which case prophylaxis for endocarditis