Ischemic heart disease is caused by a constriction of the coronary arteries reducing blood supply and oxygen to the heart. Key predisposing factors include smoking, hypertension, high fat diet, stress, and genetic predisposition. There are different types of ischemic heart disease including chronic forms with no acute symptoms, angina which causes temporary chest pain, and myocardial infarction where there is irreversible damage due to complete artery occlusion. Management involves stopping any dental treatment, activating emergency services, giving medications like nitroglycerin and aspirin, and oxygen supplementation. Dental procedures require consideration of medications the patient is taking and reducing stress and trauma.

1. Ischemic
Heart Diseases
BY : CEZAR E. LAHHAM

2. Outline :
▪ Definition
▪ predisposing factors
▪ Types
▪ Management
▪ Dental considerations

3. Definition
▪ Ischemia = Oxygen supply
▪ Ischemic heart disease= constriction in the coronary artery
= Blood supply to the heart
= Oxygen

4. Predisposing factors
▪ Smoking
▪ Exercise ??!!
▪ Genetic ~30%
▪ Hypertension
▪ Too much fat exposure
▪ Stress
▪ Rare~ mal-formed coronary artery
~Tumors adjacent to artery

5. Types
▪ Chronic ▪ Acute Angina Pectoris Stable
Unstable
MI Prinzmetal

6. Chronic IHD
NO ACUTE PHASE!!

7. Acute IHD

8. -Chest pain(retrosternal pain)
-Extends to the left hand
-Shoulder
-Neck
-Lower jaw
Other features : (more related to MI)
-Sweating
-Nausea& Vomiting
-Pallor
CLINICAL FEATURES OF ACUTE IHD

9. Angina ~reversible
Stable
▪ With predisposing factors
▪ Lasts <5 mins
Unstable
▪ Without predisposing factors
@Rest
▪ Lasts >10 mins

10. Add a Slide Title - 3

11. Management :-
-Stop treatment
-Remove any object from pt’s mouth
-Stress reduction protocol
-Activate EMS if this is a 1st attack for a pt or it happens to
be a worsen attack for a pt with a past history of angina
attacks
-UPRIGHT position
-Give NG 0.3 mg SL then check BP ! After that if the pain is
continued Give another NG
(You can until 3 tabs “Btw them 1.5 min”)
- Give 4-6 L/min Oxygen
- -If pt doesn’t respond to treatment  ER

13. Myocardial Infartion
-Complete occlusion in coronary artery
-Irrevesible necrosis in heart tissues =Irreversible damage
-1st MI <2nd MI < 3rd MI < < < severity
-Lasts > 15 mins
-Crushing type chest pain

14. Management
-Stop treatment & remove objects for pt’s mouth
-Activate EMS
-Lay the pt down to access ABC & monitor vital signs
-Give MONA
2-5 mg Morphine & Oxygen “4-6 l/min” & Nitroglycerin 0.3 SL & 162-325 mg Aspirine
-Monitor the breathing & Pulse
CPR in case of cardiac arrest

15. Dental Considerations

17. Common drugs
▪ After “Chief complaint”  Medical history
▪ Dental History
▪ Examination
▪ Drug-Drug interaction (e.g cipro&warfarin )
▪ STRESS
Aspirin
Cholesterol-reducing M (-statins)
ACE inh
B Blockers
ARB
Nitroglycerin
Others

18. PREVENTION
Check BP
Check cholesterol level :HDL& LDL
Medications
Consultation from physician to stop
any anticoagulant drug
Reduce the stress & trauma during
any procedure
.
.