Dental patients at risk with the use of epinephrine
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Dental patients at risk with the use of epinephrine. HTN CVA ASCAD- MI Cardiac arrythmias hyperthyroid sickle-cell anemia cocaine abuse MAOI. Cardiac arrhythmias- general causes. ASCAD other CVD( CHD, MI, CHF, RHD, etc.) pulmonary (COPD) autonomic disorders thyroid disease

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Dental patients at risk with the use of epinephrine
Dental patients at risk withthe use of epinephrine

  • HTN

  • CVA

  • ASCAD- MI

  • Cardiac arrythmias

  • hyperthyroid

  • sickle-cell anemia

  • cocaine abuse

  • MAOI


Cardiac arrhythmias general causes
Cardiac arrhythmias- general causes

  • ASCAD

  • other CVD( CHD, MI, CHF, RHD, etc.)

  • pulmonary (COPD)

  • autonomic disorders

  • thyroid disease

  • medical-systemic diseases

  • drug side effects

  • electrolyte imbalances


Cardiac arrhythmias patient detection
Cardiac arrhythmias- patient detection

  • signs: rapid or slow pulse

  • signs: irregular pulse rhythm

  • signs: weak pulse

  • symptoms: palpitations, dizziness, syncope angina, dyspnea, fatigue


Cardiac arrhythmias symptoms
Cardiac arrhythmias-symptoms

  • palpitations

  • heart failure

  • fatigue

  • dyspnea

  • dizziness

  • angina

  • syncope


Cardiac arrhythmias physical signs
Cardiac arrhythmias-physical signs

  • bradycardia( <60 beats per minute)

  • tachycardia( >100 beats per minute)

  • irregular pulse rhythm ( regular irregularities, irregular irregularities)


Ectopic beats
Ectopic beats

  • premature atrial beats

  • premature atrio-ventricular beats

  • premature ventricular beats ( PVCs ) most common


Atrial fibrillation
Atrial fibrillation

  • very common

  • may or may not be serious

  • irregular ventricular response

  • poor atrial transport

  • emboli


Cardiac arrhythmias management
Cardiac arrhythmias-management

  • ID patients, physical status, risk assessment

  • other CVD ( i.e. ASCAV, CHF, RHD, MI, CHF, etc.)

  • other medical-systemic ( thyroid, COPD, MAOI, etc.)


Cardiac arrhythmias id patients at risk
Cardiac arrhythmias-ID patients at risk

  • HISTORY

  • MEDICATIONS

  • STATUS

  • MONITORING

  • PHYSICAL EVALUATION = signs and symptoms

  • MEDICAL CONSULTATION


Cardiac arrhythmias management1
Cardiac arrhythmias-management

  • antiarrhythmic medications ( type, dosage, indications, when adjusted, monitored, etc.)

  • implanted pacemakers

  • pulse rate, rhythm, character, etc.


Cardiac arrhythmias medications
Cardiac arrhythmias-medications

  • Digoxin- slows conduction in the A-V node

  • Digitoxin- same- more powerful

  • quinidine- depresses ectopic

  • procainamide- ventricular arrhythmias

  • verapamil- regulates Ca++ in slow channels

  • sotalol/propanolol- beta-blokers

  • disopyramide- depresses automaticity

  • lidocaine- emergency Tx


Bleeding problems due to coumadin
Bleeding problems due to Coumadin

  • 10-40 % of hospital admissions for bleeding

  • age-dependent

  • strength and duration of coumadin Rx

  • reduction of bleeding with proper anticoagulant monitoring

  • guideline-based recommendations


Cardiac arrhythmias management2
Cardiac arrhythmias-management

  • Close monitoring: vital signs: HR & rhythm

  • Stress-anxiety reduction

  • Open-honest communication

  • Short-non-stressful appointments

  • Limit/avoid epinephrine

  • Premedication( daizepam, N2O2)


Cardiac arrhythmias id patients at risk1
Cardiac arrhythmias-ID patients at risk

  • SYMPTOMATIC

  • Palpitations

  • Dizziness

  • Syncope

  • Angina

  • dyspnea


Cardiac arrhythmias id patients at risk2
Cardiac arrhythmias-ID patients at risk

  • Patients with signs and symptoms:

  • NO TREATMENT!

  • IMMEDIATE REFERRAL FOR MEDICAL MANAGEMENT


Cardiac arrhythmias cardiac arrest
Cardiac arrhythmias-CARDIAC ARREST

  • Ventricular fibrillation progresses to MI

  • Ventricular asystole no conduction

  • Agonal rhythm conduction


Cardiac arrhythmias pacemakers
Cardiac arrhythmias-PACEMAKERS

  • Generator

  • Lead

  • electrode


Cardiac arrhythmias pacemakers1
Cardiac arrhythmias-PACEMAKERS

  • Type of pacemaker

  • Type of arrhythmia

  • Degree of shielding

  • Date of / complications from implantation


Cardiac arrhythmias pacemakers2
Cardiac arrhythmias-PACEMAKERS

  • ELECTOMAGNETIC INTERFERENCE

  • Cellular telephone

  • Microwave ovens

  • Electrocautery

  • Ultrasonic scalers

  • Electric pulp testers


Cardiac arrhythmias pacemakers3
Cardiac arrhythmias-PACEMAKERS

  • ELECTOMAGNETIC INTERFERENCE

  • Cellular telephone

  • Microwave ovens

  • Electrocautery

  • Ultrasonic scalers

  • Electric pulp testers

x


Cardiac arrhythmias pacemakers4
Cardiac arrhythmias-PACEMAKERS

  • Symptomatic sinus bradycardia

  • Symptomatic A-V block( 1,2,3)

  • Tachycardias refractory to Rx therapy


Cardiac arrhythmias medications side effects
Cardiac arrhythmias-medications side effects

  • Lichenoid reactions

  • Lupus erythematosus lesions

  • Digitalis

  • Quinidine

  • Procainamide


Cardiac arrhythmias

CARDIACARRHYTHMIAS

Dr. Nelson L. Rhodus

Distinguished Professor

Director of Oral Medicine

University of Minnesota


Bradycardias
Bradycardias

  • sinus bradycardia( normal EKG pattern) <60 BPM

  • sinoatrial heart block

  • atrioventicular heart block ( AV-1,2,3 degrees)


Tachycardias
Tachycardias

  • sinus tachycardia ( >100 per minute)

  • atrial tachycardia ( >150-200 per minute)

  • atrial flutter ( >220-360 per minute)

  • atrial fibrillation ( >400-650 per minute)

  • ventricular tachycardia ( 3 or more at >100 per minute)