Management of Patients with
Ischemic heart disease
Presented by Mariam Bachani
Objectives
Definition
Pathophysiology
Risk Factors
Signs and Symptoms
Management
Ischaemic heart disease
• Ischemic) heart disease is a disease characterized by
reduced blood supply to the heart.
• The coronary arteries supply blood to the heart ,so a
blockage in the coronary arteries reduces the supply
of blood to heart
• Most ischaemic heart disease is caused by
atherosclerosis, usually present even when the artery
lumens appear normal by angiography.
• The narrowing or closure is predominantly caused by
the covering of atheromatous plaques within the wall
of the artery rupturing, in turn leading to a heart
attack
Atherosclerosis
• Progressive inflammatory disorder of arterial wall ,
characterized focal lipid rich deposit of atheroma
that remain silent until it become large or until
disruption of lesion result in thrombotic occulusion
or embolization of affected vessels
• The underlying pathogenesis of coronary artery
disease is atherosclerosis
• Atherosclerosis is a condition where the arteries
become narrowed and hardened due to a buildup of
plaque around the artery wall.
ANGINA PECTORIS
• Is a symptoms occurring when imbalance
myocardial supply and demand causes transient
myocardial ischemia
• However the symptom may also manifestation of
other disease such as aortic valve
disease,hypertrophic cardiomyopathies or
coronary vasospam (prinzmental angina)
Clinical Signs and Symptoms
• Chest pain, or discomfort,
• heavy pressure,
• squeezing,
• burning or strangling sensation in patient substernal region
• Pain radiating in the left shoulder, arms, or even mandibular
region
• Unable to breath adequately
• Sweating
• bradycardia
• nausea
Types of Angina
Stable/Atherosclerotic Angina:
• Also known as angina of effort or classic angina
• Stable angina can also be referred to as exertional
angina
• Associated with atheromatous plaque that partially
occlude one or more coronary arteries.
• Pain relieves by rest within 15 min
• This type of angina constitute about 90% of angina
cases
Unstable / Crescendo Angina:
• Also known as Acute Coronary Syndrome
• It require emergency treatment
• Characterized by increase frequency and severity of
attacks that result from a combination of
atherosclerotic plaques , platelet aggregation at
fractured plaques and vasospasm
• It is an immediate precursor of Myocardial Infarction
and is treated as a medical emergency.
Vasospastic / Prinzmetal’s Angina
• It involves reversible spasm of coronaries, usually at
the site of an athrosclerotic plaque.
• Spasm may occur at any time, even during sleep.
• This type of angina may deteriorate into unstable
angina
• Responsible for less then 10% of cases.
RISK FACTORS
• Primarily in men older than 40 years
• Postmenupausal women
• Stress
• Smoking
• High Blood pressure
• High blood cholesterol
• Family history of Heart Disease
• Lack of exercise
• Obesity
• Unhealthy diet
Management of Patient with history of
Angina
Before Appointment:
1. Consult the physician about the patient’s
cardiac status
2. Take a detailed, careful medical history.
3. (frequency, duration and severity of angina,
precipitating factors)
4. Anxiolytics
5. Short morning appointments
• During appointment:
1. Follow anxiety reduction protocol
2. Patients attained comfortable position , reassured
3. Have nitroglycerin tablets(0.4mg) or spray (400mg/spray) readily available
(prophylaxis)
4. Monitor vital signs closely
5. Limit the dose of local anesthesia(0.04mg max)
6. Maintain verbal contact with the patient throughout the procedure
7. No surprises
8. No unneccesary noise
After surgery:
1. Patient information on Expected post surgical
sequelae
2. Reassurance
3. Effective analgesics
4. Number to contact if any problem arises
Management of patient with angina episode during
dental treatment
1. Defer the treatment
2. Patient is allowed to attain a comfortable position
3. Patient is reassured and garments are loosened
4. NTG spray to be given, nitroglycerin, nitrous oxide-
oxygen sedation, and slow delivery of an anesthetic with
epinephrine (1:1,00,000) coupled with aspiration.
5. Monitor vitals
6. Oxygen administration
7. If no improvement >5 mins MI is suspected hence should
be rushed to the hospital.
MYOCARDIAL
INFARCTION
• Myocardial infarction (MI) (i.e., heart attack) is the irreversible death
(necrosis) of heart muscle secondary to prolonged ischemia and hypoxia.
Clinical Signs and Symptoms
• Sudden onset of chest pain that is crushing and severe
pain
• Shortness of breath
• Tachycardia
• Sweating
• Nausea
• Vomiting
• Anxiety
• Cough
• Dizziness
• Syncope
Management of patient with a history
of Myocardial Infarction
• Consult patient’s primary care physician
• Past medical history
• Short morning appointments
• Use an anxiety reduction protocol
• Prophylactic nitroglycerine
administration
• Nitrous oxide administration
• Monitor vital signs
• Maintain verbal contact
