 Ischemic Heart Disease

 Myocardial Infarction
 Congested Heart Failure
By: Anna Rusnak, Scott Sonnier,& Iesha Washington
 Disease of the heart and blood vessels.
https://youtu.be/TExCF_mqjHQ

This short video provides some theories of how the two are
connected.
ISCHEMIC HEART DISEASE
CHD)
 Definition:
 The cardiac disability, acute and chronic, that arises from reduction
or arrest of blood supply to the myocardium (heart muscle).

 Ischemia means oxygen deprivation in a local area from a reduced

passage of blood into the area.

 Etiology:
 Atherosclerosis- fibro-fatty deposits or plaque containing several
lipids, especially cholesterol that thicken over time and eventually
close the vessel.
 The treatment and medication depend upon what type manifestation
the patient has of this disease.

 3 MAINFESTATIONS OF ISCHEMIC HEART DISEASE

 Angina
 Myocardial Infarction
 Congestive Heart Failure
 Definition: Chest pain due to lack of oxygen to the heart muscle.

 Etiology: Ischemic Heart Disease caused by atherosclerosis

 2 types of Angina:
 Stable Angina- The chest pain happens because of some type of
exertion ( eating, exercise, emotional stress)
 Unstable Angina- The chest pain happens while the patient is
resting.

 Important Note: Check with patient before starting dental procedure to make sure
they have their Nitroglycerin RX with them.
TREATMENT AND MEDICATION
 Treatment during Angina Attack  Medication used during Angina
Attack
1. Stop all treatment, call for help and
the ER kit, Sit the patient up-right.
2. Give 1st dose of sublingual  NITROGLYCERIN: This medication is
nitroglycerin…check patient’s a vasodilator.
response…a 2nd dose of sublingual
 It works by opening up(dilating) the
nitroglycerin can be given.
blood vessels to allow more blood
3. Call 911 if patient does not flow to the heart. More blood flow
respond to the 2nd dose. means more oxygen.
4. Monitor vitals throughout this ER
treatment.
 Definition:
 It is a sudden reduction or arrest of coronary blood flow.
 The most extreme manifestation of Ischemic Heart Disease.

 Etiology:
 Immediate cause: can be thrombosis that blocks an artery narrowed by
atherosclerosis.
 The blockage creates an area of infarction, which leads to necrosis.
 Sudden death may occur immediately or within a few hours.
 Other names
 Heart attack, coronary occlusion, or coronary thrombosis

Symptoms may include:

Pain in the chest with a feeling of nausea or heartburn

Faint or weak feeling with a cold sweat

ER TREATMENT
 Stop all dental treatment…Sit patient up for comfort.

 Give nitroglycerin and reassure the patient.

 If angina like symptoms do not reduce within 3 minutes, prepare to

give CPR

 CALL 911. Administer oxygen.

 Give CPR, if indicated, while waiting for medical assistance, monitor

vitals throughout this ER situation.
NO ELECTIVE DENTAL TREATMENT UNTIL MD HAS GIVEN CLEARANCE
 Follow up care with MD and  Lifestyle Changes:
frequent supervision by MD  Diet
 Tobacco Cessation
 The patient may have extreme  Control of any other systemic
fatigue after a heart attack. conditions
 Maintain periodontal health

 The patient will need a short

We need to Educate and
rest period followed by activity Encourage and Motivate
to regain strength. patients following a heart
attack.
 MEDICATIONS

Oral Implications:
 Aspirin
increased bleeding
 Heparin burning mouth, taste loss, dry cough
xerostomia
 ACE inhibitors
gingival enlargement
 Antiplatelet (Blood thinners)
 Beta blockers
 Calcium Channel Blockers
 When (Date) did the heart attack occur?
 What treatment were you given after the heart attack?
Surgery?
 What are your current medications?
 How has your health been since the heart attack?
 Are you making any lifestyle changes to help prevent future
emergencies?
 When was your last MD check up and what were his
findings?
 Definition:
 A syndrome in which an abnormality Symptoms of LEFT side failure:
of cardiac function is responsible for
the inability or failure of the heart to Trouble breathing, cough
pump blood at a rate necessary to Cold and pale skin
meet the oxygen needs of the body
tissues. Increased or rapid heart rate
 Etiology:
Increased diastolic BP
 Coronary heart disease
 Hypertension Symptoms of RIGHT side failure:
 Diabetes Edema of extremities
 Arrhythmias Blue color to lips and nail beds, cold
 Congenital heart disease hands and feet
 Thyroid disorders
Edema becomes worse in late stages of
 Alcohol or illegal drug use like
cocaine CHF
 HIV/AIDS
 CHF
 Medications  Oral impact
 Ace inhibitors  Burning mouth, taste loss, dry cough
 ARBs  Xerostomia
 Beta blockers  Swelling of tongue
 Digoxin

 Surgical procedures Dental Considerations with

 Coronary Dilation CHF
 Coronary angioplasty  Use a semi supine or upright chair position
 Coronary stent because of breathing and circulation problems
 Coronary Bypass  Use stress reduction protocol
 Cardiac Pacemaker  Patient ED regarding any medication side
effects
 Population:
 Tobacco users, diabetics, obesity, insufficient physical activity, increased tension,
emotional stress, and family history.
 Avoid ultrasonic with patients with pacemaker.
 Link between periodontal pathogens and cardiovascular diseases.
 RDH needs to EDUCATE patients about the significant relationship between oral
health and systemic health.
 Wait 6 months before getting dental treatment after a heart attack.

 After the 6 month waiting period. Recall should be maintained every 3 months.
 Congestive heart failure/Ischemic heart failure
 Consult physician to determine the need for antibiotic premedication.
 Susceptibility to bacterial endocarditis.
 May have breathing problems so semi-upright position in dental chair
 Minimize stress
 If taking diuretic; possible xerostomia

 Myocardial Infarction:
 No elective dental treatment for 6 months
 Bleeding tendency if taking anticoagulant or aspirin
 Monitor vital signs
 Minimize stress with shorter appointments
 Early morning appointments
True/False: A patient who had a heart attack last month does not need a medical
release for dental treatment.

What medication is given during an active angina attack and a heart attack?
Aspirin
Warfarin
Nitroglycerine
NSAIDs

True/False: Myocardial Infarction is the most common symptom of Ischemic Heart Disease?

True/False: Angina is the most severe manifestation of Ischemic Heart Disease?