Angina pectoris And dental treatment protocol

 

Angina pectoris

 And dental treatment protocol

Is an ischemic heart disease characterized by reduction blood supply of the heart muscle, usually due to coronary artery disease

Is a clinical syndrome characterized by paroxysmal  chest pain due to transient myocardial ischemia  resulting from imbalance between coronary blood  flow &  oxygen demand

 

It is characterized by:

•Temporary

•Constant chest pain not more than 30min.

•Typically precipitated by effort & relieved by rest

Angina

Stable Angina occurs with exertion or stress

Unstable   Anginaoccurs at rest or often without exertion or stress. 

Variant  Anginatransient ST-segment elevation on electrocardiogram during an attack of chest pain with high frequency of asymptomatic ischemic episodes and the syncope

Etiology

1-Decreased coronary blood flow due to mechanical obstruction such as:

•Atheroma

•Spasm of coronary artery

•Thrombosis

•Embolism

•Coronary artreritis

2-Increased myocardial oxygen requirement :

•Increased cardiac output :thyrotoxicosis

•Myocardial hypertrophy: aortic stenosis , hypertension

3-Decreased flow of oxygenated blood :

•anemia

Angina symptoms include:

•Chest pain or discomfort

•Pain in arms, neck, jaw, shoulder or back accompanying chest pain

•Nausea

•Fatigue

•Shortness of breath

•Anxiety

•Sweating

•Dizziness

Chest pain or discomfort is usually felt as:

•pressure,

•heaviness,

•tightening,

•squeezing    

Dental  management

"Unstable Angina" major risk

Elective dental care should be deferred,  if care  becomes necessary,  it should be provided   in consultation with the physician.

Management may include establishment of an IV  line; sedation; monitoring of electrocardiogram,  pulse oximeter, and blood pressure; oxygen; 

cautious use of vasoconstrictors; and prophylactic  nitroglycerin.

"Stable Angina " intermediate risk

Elective   dental care   may      be  provided,         with     the  following management considerations:

For stress and anxiety reduction:

Oral sedative premedication  and/or  inhalation  sedation

Prophylactic nitroglycerin

Short appointments , ideally in the morning when the patient is well-rested and has a greater physical reserve

-Provide local anesthesia of excellent quality and adequate pain control.

For patients taking a nonselective beta blocker:

Limit epinephrine  to  less than 2  cartridges of epi  1 :100000

Avoid   use of epinephrine-impregnated  gingival  retraction cord.

Avoid anticholinergics.

Provide  local anesthesia  of excellent quality and  adequate postoperative pain control.

If patient is taking aspirin : Bleeding usually is  manageable with local measures only; discontinuation of  medication is not recommended.

Antibiotic prophylaxis is not recommended for patients  with a history of coronary artery bypass graft (CABG),  angioplasty, or stent.

 For more reading download :

👆Dental management of medically compromised patient PDF

👆Crispian skully medical proplems in dentistry

👆 Contemporary oral and maxillofacial surgery PDF

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