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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 - PowerPoint PPT Presentation
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Dental patients at risk withDental patients at risk withthe use of epinephrinethe use of epinephrine
HTN CVA ASCAD- MI Cardiac arrythmias hyperthyroid sickle-cell anemia cocaine abuse MAOI
Cardiac arrhythmias- Cardiac arrhythmias- general causesgeneral 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- Cardiac arrhythmias- patient detectionpatient detection
signs: rapid or slow pulse signs: irregular pulse rhythm signs: weak pulse symptoms: palpitations, dizziness, syncope
angina, dyspnea, fatigue
Cardiac arrhythmias-Cardiac arrhythmias-symptomssymptoms
palpitations heart failure fatigue dyspnea dizziness angina syncope
Cardiac arrhythmias-Cardiac arrhythmias-physical signsphysical signs
bradycardia( <60 beats per minute) tachycardia( >100 beats per minute) irregular pulse rhythm ( regular
irregularities, irregular irregularities)
Ectopic beatsEctopic beats
premature atrial beats premature atrio-ventricular beats premature ventricular beats ( PVCs )
most common
Atrial fibrillationAtrial fibrillation
very common may or may not be serious irregular ventricular response poor atrial transport
emboli
Cardiac arrhythmias-Cardiac arrhythmias-managementmanagement
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-Cardiac arrhythmias-ID patients at riskID patients at risk
HISTORY MEDICATIONS STATUS MONITORING PHYSICAL EVALUATION = signs and
symptoms MEDICAL CONSULTATION
Cardiac arrhythmias-Cardiac arrhythmias-managementmanagement
antiarrhythmic medications ( type, dosage, indications, when adjusted, monitored, etc.)
implanted pacemakers pulse rate, rhythm, character, etc.
Cardiac arrhythmias-Cardiac arrhythmias-medicationsmedications
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 Bleeding problems due to
CoumadinCoumadin
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-Cardiac arrhythmias-managementmanagement
Close monitoring: vital signs: HR & rhythm Stress-anxiety reduction Open-honest communication Short-non-stressful appointments Limit/avoid epinephrine Premedication( daizepam, N2O2)
Cardiac arrhythmias-Cardiac arrhythmias-ID patients at riskID patients at risk
SYMPTOMATIC Palpitations Dizziness Syncope Angina dyspnea
Cardiac arrhythmias-Cardiac arrhythmias-ID patients at riskID patients at risk
Patients with signs and symptoms: NO TREATMENT! IMMEDIATE REFERRAL FOR
MEDICAL MANAGEMENT
Cardiac arrhythmias-Cardiac arrhythmias-CARDIAC ARRESTCARDIAC ARREST
Ventricular fibrillationprogresses to MI
Ventricular asystoleno conduction
Agonal rhythm conduction
Cardiac arrhythmias-Cardiac arrhythmias-PACEMAKERSPACEMAKERS
Generator Lead electrode
Cardiac arrhythmias-Cardiac arrhythmias-PACEMAKERSPACEMAKERS
Type of pacemaker Type of arrhythmia Degree of shielding Date of / complications from implantation
Cardiac arrhythmias-Cardiac arrhythmias-PACEMAKERSPACEMAKERS
ELECTOMAGNETIC INTERFERENCE Cellular telephone Microwave ovens Electrocautery Ultrasonic scalers Electric pulp testers
Cardiac arrhythmias-Cardiac arrhythmias-PACEMAKERSPACEMAKERS
ELECTOMAGNETIC INTERFERENCE Cellular telephone Microwave ovens Electrocautery Ultrasonic scalers Electric pulp testers
Cardiac arrhythmias-Cardiac arrhythmias-PACEMAKERSPACEMAKERS
Symptomatic sinus bradycardia Symptomatic A-V block( 1,2,3) Tachycardias refractory to Rx therapy
Cardiac arrhythmias-Cardiac arrhythmias-medications side effectsmedications side effects
Lichenoid reactions Lupus erythematosus lesions Digitalis Quinidine Procainamide
CARDIACCARDIACARRHYTHMIASARRHYTHMIAS
Dr. Nelson L. Rhodus
Distinguished Professor
Director of Oral Medicine
University of Minnesota
BradycardiasBradycardias
sinus bradycardia( normal EKG pattern)<60 BPM
sinoatrial heart block atrioventicular heart block ( AV-1,2,3
degrees)
TachycardiasTachycardias
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)