Myocardial infarction , And dental treatment protocol
Myocardial infarctionAnd
dental treatment protocol
Is
an ischemic heart disease characterized by reduction
blood
supply of the heart muscle,
usually due to coronary artery disease
Myocardial infarction,
commonly known as a heart attack, is the irreversible necrosis of heart muscle secondary to prolonged ischemia
(total obstruction
The
pain resulting from infarction is:
1.More severe than anginal pain,
2.Lasts longer.
3.Not relieved by vasodilators
(It needs IM morphine sulfate administration).
Laboratory
findings :
Creatine
phosphokinase :it is the most sensitive &specific marker ; as it appears within 4hrs post-infarction.
โขAspartatetransaminase(AST):it is elevated after 12hrs.
โขLactic dehydrogenase(LDH):it is used in patients admitted to the hospital ;it appears 48-72hrs after the onset of symptoms.
Etiology
the same as for angina pectoris
1-Decreased
coronary blood flow due to mechanical obstruction such as:
โขAtheroma
โขSpasm
of coronary artery
โขThrombosis
โขEmbolism
โขCoronary
artreritis
2-Increased
myocardial oxygen requirement :
โขIncreased
cardiac output :thyrotoxicosis
โขMyocardial
hypertrophy: aortic stenosis , hypertension
3-Decreased
flow of oxygenated blood :
โขanemia
Typical symptoms of myocardial infarction include
sudden
chest
pain,
shortness of breath,
nausea,
vomiting,
palpitations,
sweating
weakness,
light-headedness
Collapse/syncope
Severe
pain
โขdescribed
as a sensation of tightness, pressure, crushing or squeezing.
โขradiating
to left(ยฑright) shoulder/arm/ neck/jaw
โขChest
pain usually lasts for more than 15 minutes
โขNot
relieves by rest
Dental management
Recent Myocardial
Infarction (<1 month)โmajor 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.
Past Myocardial Infarction (>1month without symptoms)โ intermediate risk
โขElective 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 blockers :
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
If patient is taking warfarin
(Coumadin), the INR should be 3.5 or less before performance of invasive procedures.
If patient has a pacemaker or implanted defibrillator, avoid use of electrosurgery and ultrasonic scalers;
Antibiotic prophylaxis is not recommended for these patients.
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