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Angina and mi
- 2. Ischemic heart diseas: Ischemic heart disease OR coronary arteries disease occurs when there is insufficient blood flow to a part of heart muscle due to blockage in the blood vessels leading to the area. Any blockage in the coronary arteries reduce the blood supply to heart muscle. Types: angina & MI 2 Definition
- 3. Angina 3
- 4. Content • Definition • Epidemiology • Etiology • Classification • Signs & symptoms • precipitation causes • Pathophysiology • Complications • Oral manifestation • Diagnosis • Treatment & Management • References 4
- 5. Definition Angina is chest pain or discomfort caused when your heart muscle doesn't get enough oxygen-rich blood. Angina pain may even feel like indigestion. But, angina is not a disease 5 Definition
- 6. 2008 2010 2014 approximately 112 million people (1.6% of the population) angina due to ischemic heart disease affects approximately 112 million people (1.6% of the population) being slightly more common in men than women (1.7% to 1.5%) 6 Epidemiology approximately 90 million people approximately 150 million people (2.2% of the population)
- 7. • Atherosclerosis • Coronary artery spasm • Use of cocaine • Blockage of coronary artery by blood clot compression • Inflammation or infection of coronary artery • Injury to coronary artery • Poor functioning of tiny blood vessels 7 Etiology Etiology • Age (≥ 45 years for men, ≥ 55 for women) • High blood pressure • Smoking • Diabetes mellitus • Dyslipidemia • Family history of premature cardiovascular disease (men <55 years, female <65 years old) • Overweight or obesity • Unhealthy diet
- 8. 8 Type Classification 2)Stable angina : pain only in excretion and relieves with rest and medication 1)Acute coronary syndrome(unstable angina) :angina at rest or sudden on set with rapid increase with severity(due to transit subtotal obstruction of coronary artery 4)Vazospastic angina(variant or prinzmetal):caused by coronary artery spasm 3)Decubitus angina :pain on lying down 5)Cardiac syndrome X, sometimes known as microvascular angina is characterized by angina-like chest pain
- 9. 9 Pain in your arms, neck, jaw, shoulder or back accompanying chest pain Chest pain or discomfort, possibly described as pressure, squeezing, burning or fullness Nausea. Fatigue. Shortness of breath. Sweating. Dizziness Signs & symptoms
- 10. 10 *Physical exertion (particularly in cold weather ). precipitation causes *emotion: anger or anxiety). Stress caused by fear or pain leading to release of catecholamine's ( adrenalin/ epinephrine noradrenaline/norepinephrine) and consequent tachycardia, vasoconstriction and raised blood pressure.
- 11. results when there is an imbalance between the heart's oxygen demand and supply. This imbalance can result from an increase in demand (e.g., during exercise) without a proportional increase in supply (e.g., due to obstruction or atherosclerosis of the coronary arteries 11 Pathophysiology
- 12. 12 Complications ● Atrioventricular block (i.e., absence of electrical conduction between the atrium and ventricle) ● Episodes of disabling pain Heart attack ● Severe arrhythmias ● Sudden cardiac death (sudden cardiac arrest [SCA]
- 13. 13 Gingival hyperplasia can be caused by calcium channel blockers Taste changes and lichenoid lesions2 can result from beta-blocker use There are no oral findings specific to angina (or coronary atherosclerotic heart disease in general); however, medications used to treat angina can result in oral changes. Oral Manifestation of angina Lupus-like oral and skin lesions can result from use of direct vasodilators Bleeding — manifesting as petechiae, hematomas, or gingival bleeding — may occur in patients/clients receiving antiplatelet or anticoagulant treatment. may experience pain referred to the mandible or teeth suggested by a pattern of onset of pain with physical activity and its disappearance with rest.
- 14. 14 Diagnisis ● Electrocardiogram (ECG or EKG). Each beat of your heart is triggered by an electrical impulse generated from special cells in your heart. ... ● Stress test. ... ● Echocardiogram. ... ● Nuclear stress test. ... ● Chest X-ray. ... ● Blood tests. ... ● Coronary angiography. ... ● Cardiac computerized tomography (CT) scan
- 15. 5)Enhanced external counterpulsation. (when other methods fail) 2)medication *(GTN)that (relax and widen your blood vessels, allowing more blood to flow to your heart muscle) * Aspirin (prevent blood clotting) *Clot-preventing drugs like (clopidogrel) can help prevent blood clots from forming by making your blood platelets less likely to stick together *Beta blockers(act on epinephrine )and reduce blood pressure *statin used to lower blood cholesterol * Calcium channel blockers relax and widen blood vessels *Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications 4) Coronary artery bypass surgery 3)Angioplasty and stenting 1)Lifestyle changes 15 Treatment & Management
- 16. 16 Management In Dental clinic • 1)Consultation of physician to control the condition. • 2)Use anxiety reduction protocol such as short duration atraumatic procedures • 3)Preoperative nitroglycerine or sometimes sedations (oral diazepam) is useful. • 4 )Conscious sedations and general anesthesia should be avoided in patients with recent angina, unstable angina and MI. • 5) Avoid adrenalin- containing Local Anesthetic solutions, because adrenalin is a cardiac stimulant that may precipitate angina or cardiac arrest.
- 17. 17 Management In Dental clinic • 6)If the patient have developed angina intraoperatively: • Stope the procedure. • Give nitroglycerine • Give oxygen • Monitor vital signs. • Accompany the patient to home. • If the patient not relived within 5 minutes repeat nitroglycerine 3 times for 15-20 minutes. • If the pain persists and other symptoms such as nausea, vomiting and syncope and hypertension the myocardial infarction (MI).
- 19. Content • Definition • Etiology • Classification • Signs & symptoms • Deference between MI & Angina • Pathophysiology • Complications • Oral manifestation • Diagnosis • Treatment & Management • References 19
- 20. Definition Myocardial infarction (MI), also known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle 20 Definition
- 21. • Atherosclerosis • Coronary artery spasm • Use of cocaine • Blockage of coronary artery by blood clot compression • Inflammation or infection of coronary artery • Injury to coronary artery • Poor functioning of tiny blood vessels 21 Etiology Etiology • Age (≥ 45 years for men, ≥ 55 for women) • High blood pressure • Smoking • Diabetes mellitus • Dyslipidemia • Family history of premature cardiovascular disease (men <55 years, female <65 years old) • Overweight or obesity • Unhealthy diet
- 22. 22 Type Classification Spontaneous MI related to plaque erosion and/or rupture, fissuring, or dissection MI related to ischemia, such as from increased oxygen demand or decreased supply, e.g. coronary artery spasm, coronary embolism, anemia, arrhythmias, high blood pressure or low blood pressure
- 23. 23 shortness of breath Sweating pressure or tightness in the chest pain in the chest, back, jaw, and other areas of the upper body that lasts more than a few minutes or that goes away and comes back anxiety cough dizziness fast heart rate nausea vomiting Signs & symptoms
- 24. MI • As for angina • Often no obvious precipitant • Not relieved by rest, nitrates • Usually severe (may be silent) • Severe • Nausea and vomiting are common • Increased sympathetic activity ANGINA 24 DIFFERENCE BETWEEN ANGINA AND MI • Site: retrosternal, radiate to arm, epigastrium, neck • Precipitated by exercise or emotion • Relieved by rest, nitrates • Mild/moderate severity • Anxiety absent or mild • No nausea and vomiting • No increased sympathetic activity
- 25. This most commonly occurs when a coronary artery becomes occluded following the rupture of an atherosclerotic plaque, which then leads to the formation of a blood clot (coronary thrombosis). ... After several weeks, the infarcted tissue forms a fibrotic scar 25 Pathophysiology
- 26. 26 Complications ● Disturbance of rate, rhythm and conduction. ... ● Cardiac rupture. ... ● Ventricular septal defect ● Ventricular aneurysm. ● Ruptured papillary muscles. ... ● Dressler's syndrome ● Heart failure. ... ● Pericarditis.
- 27. Gingival hyperplasia Oral Manifestation of MI Xerostomia Taste changes Stomatitis 27
- 28. 28 Diagnisis ● Electrocardiogram (ECG or EKG). Each beat of your heart is triggered by an electrical impulse generated from special cells in your heart. ... ● Stress test. ... ● Echocardiogram. ... ● Nuclear stress test. ... ● Chest X-ray. ... ● Blood tests. ... ● Coronary angiography. ... ● Cardiac computerized tomography (CT) scan
- 29. 5)Enhanced external counterpulsation. (when other methods fail) 2)medication *(GTN)that (relax and widen your blood vessels, allowing more blood to flow to your heart muscle) * Aspirin (prevent blood clotting) *Clot-preventing drugs like (clopidogrel) can help prevent blood clots from forming by making your blood platelets less likely to stick together *Beta blockers(act on epinephrine )and reduce blood pressure *statin used to lower blood cholesterol * Calcium channel blockers relax and widen blood vessels *Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications 4) Coronary artery bypass surgery 3)Angioplasty and stenting 1)Lifestyle changes 29 Treatment & Management
- 30. 30 Management In Dental clinic Patients within 6 months of MI at greater risk of another attack so 1)Dental treatments can improve arrhythmia and aggravate cardiac ischemia, so the elective procedures should be deferred. 2)Simple emergency procedures under L.A within 6 months of MI can be performed but after consultation of specialist. 3) Symptomatic patients with old history of MI (>6months) can be done safely but with stress reduction protocol. 4) The physician may advocate the preoperative use of GTN 5)Monitor the vital signs (BP, Pulse, SPO2, ECG
- 31. 31 Management In Dental clinic In case of emergency 1)Alert emergency services 2)Aspirin (300 mg); to be chewed. 3)Rest and reassure 4)Pain relief: opioid analgesia 5) Oxygen or nitrous oxide 6) Primary percutaneous intervention, or thrombolysis – streptokinase/ tissue plasminogen activator (t-PA) to dissolve the coronary thrombus. 7) Glyceryl trinitrate infusion to relief pain and prevent pulmonary edema (fluid accumulation within the lungs) 8)In Severe complication do CPR.
- 33. 33 THANKS Does anyone have any questions?