CH 9 - 12 REVIEW
List six risk factors for coronary heart disease
- Gender - Increasing age and heredity (including race) - Obesity - Physical inactivity - Use of tobacco, - High blood pressure - High cholesterol
Discuss the difference between a TIA and a CVA.
- TIA or a Transient Ischemic Attack is a brief episode of neurological dysfunction caused by ischemia of the brain in a specific location, with symptoms lasting less than one hour with no evidence of an acute stroke. - A cerebrovascular accident (CVA) or stroke is an abnormal condition of the brain characterized by occlusion or hemorrhage of a blood vessel resulting in a lack of oxygen to the brain tissues (ischemia) that normally receive their blood supply from the damaged vessels. This lack of blood supply to the blood vessels results in a loss of proper oxygenation to the brain cells and eventually cell death.
Describe the appropriate treatment for a patient suffering from angina pectoris in the dental setting.
- Terminate procedure - Upright or semisupine position - CABs - Administer O2 4-6 liters/minute - Monitor vital signs - Administer nitroglycerine if patient not hypotensive—patient is preferably or spray from kit - Can administer three doses in 15-minute period - If episode ceases can resume treatment if patient feels well enough - If pain more severe than normal or if pain does not cease contact EMS and treat as MI
Describe the appropriate treatment for a patient suffering from myocardial infarction in the dental setting.
- Terminate treatment - If hx of angina treat for angina - If no hx of angina - Position comfortably - CAB - EMS - Administer O2 4-6 liters/minute - Monitor vital signs - Administer nitroglycerine from kit if patient not hypotensive - If pain not relieved in two to four minutes administer two more doses of nitroglycerine - If pain not relieved administer 162-325 mg chewable aspirin - Monitor vital signs - Prepare for CPR if necessary
Explain the process for administration of the Prehospital Cincinnati Stroke Scale.
- The patient is asked to smile while the healthcare provider observes the patient for weakness on one side of the face. - The patient is asked to hold both arms out with palms up and eyes closed for 10 seconds while the healthcare provider observes for weakness in one arm. If there is a weakness in both arms or if normal strength is determined, then the patient tests negative for CVA. - The patient is asked to repeat a simple sentence—"The sky is blue in Cincinnati"—while the healthcare provider observes for difficulty in speech. If any of the three components are found to be abnormal then it should be assumed that the patient is experiencing a stroke and should be treated as such.
Approximately _________________ % of all CVAs are the hemorrhagic type.
15
Smokers are _________________ to _________________ times more likely to develop CAD than nonsmokers.
2; 4
. Nitroglycerine will normally reduce or eliminate anginal symptoms within a/an _________________ to _________________ minute time frame
2;4
Thrombolytic agents have been found to be effective if given within _________________ hours of the onset of symptoms.
3
_________________ % of patients being treated for hypertension are NOT controlled to blood pressure levels below 140/90.
66
A brief episode of neurological dysfunction caused by ischemia of the brain lasting less than one hour is a/an: A. TIA (transient ischemic attack). B. aneurysm. C. embolus. D. fibrillation.
A
All of the following are risk factors for CAD that are modifiable EXCEPT: A. race. B. obesity. C. high cholesterol. D. physical activity.
A
Aspirin given to a suspected AMI patient works due to its: A. antithrombotic effect. B. analgesic effect. C. antiinflammatory effect. D. all of the above.
A
Dysrhythmia may present as: A. bradycardia. B. atrial tachycardia. C. diastole. D. none of the above.
A
Edema of the abdomen in patients with heart failure indicates: A. progression of right heart failure to liver and spleen engorgement. B. edema of the central nervous system. C. renal failure. D. arrhythmias.
A
Optimal total serum cholesterol levels are less than: A. 200 mg/dL. B. 250 mg/dL. C. 300 mg/dL. D. 350 mg/dL.
A
The MOST common cause of ischemic heart disease is: A. atherosclerosis. B. hypertension. C. diabetes. D. none of the above.
A
The MOST common type of CVA is: A. thrombotic. B. embolic. C. intracerebral hemorrhage. D. subarachnoid hemorrhage.
A
The backup of fluid into the lungs seen in left ventricular heart failure often leads to: A. pulmonary edema. B. cardiac arrhythmias. C. myocardial infarction. D. none of the above.
A
The classic sign of an acute myocardial infarction is: A. chest pain lasting 20 minutes or longer. B. sharp pain in the chest. C. pain radiating down the right arm and upper back. D. regular pulse rate.
A
The type of angina that presents with predictable and reproducible discomfort in the left area of the chest lasting from 1-15 minutes induced by some form of stress is: A. stable. B. unstable. C. variant. D. Prinzmetal's.
A
What is the major difference between the signs and symptoms of a thrombotic and an embolic CVA? A. Embolic strokes have a more abrupt onset B. Thrombotic strokes have a more abrupt onset C. Embolic strokes tend to cause unconsciousness more often D. Thrombotic strokes tend to cause unconsciousness more often
A
Which is the MOST frequent cause of heart failure? A. Myocardial infarction B. Diabetes mellitus C. Valvular heart disease D. Degenerative heart conditions
A
Which of the following poses a greater risk for CAD in women than in men? A. Elevated HDL B. Increasing age C. Heredity D. Smoking
A
A necrosis of a portion of the myocardium due to total or partial occlusion of a coronary artery is a/an _________________ ________________ _______________.
Acute myocardial infarction
A/an _________________ is a weakening or ballooning of a blood vessel which, if it bursts, can lead to a CVA.
Aneurysm
A slow, complex inflammatory arterial disease that starts in childhood and often progresses with age is _________________.
Atherosclerosis
All of the following are signs and symptoms of an anginal attack EXCEPT one. Which one is the exception? A. Pressure, burning, or heaviness in the chest area B. Hypotension C. Diaphoresis D. Pallor
B
All of the following are true of Prinzmetal's angina EXCEPT one. Which one is the exception? A. More common in women under 50 B. Occurs while the person is exercising C. Occurs at odd hours of the day and night D. Can occur in persons without coronary artery disease
B
All of the following are true of cigarette smoking EXCEPT one. Which one is the exception? A. Accelerates the development of coronary plaques B. Decreases plaque rupture C. Promotes coronary thrombosis
B
Approximately _____ of adults are unaware that they are hypertensive. A. 10% B. 20% C. 30% D. 40%
B
During a CVA there is a lack of oxygen to the cerebral tissues or: A. aneurysm. B. ischemia. C. infarction. D. embolus.
B
If chest pain treated with nitroglycerine diminishes and then returns, the patient: A. is ready to be sent home. B. should be managed as an AMI. C. should be given 10 mg atropine IM. D. none of the above.
B
Nonvascular conditions associated with heart failure include all of the following EXCEPT one. Which one is the exception? A. Thyroid disease B. Cerebrovascular accident C. Pulmonary disease D. Renal insufficiency
B
The MOST dramatic life-threatening symptom of right heart failure is pulmonary edema. Acute pulmonary edema is the result of rapid accumulation of fluid in the lungs. A. The first statement is true; the second statement is false. B. The first statement is false; the second statement is true. C. Both statements are true. D. Both statements are false.
B
The appropriate dosage of aspirin to be administered to a patient suspected of experiencing an AMI is: A. 42-81 mg. B. 81-162 mg. C. 162-325 mg. D. aspirin should not be given to a patient suspected of experiencing an AMI.
B
The appropriate dosage of nitroglycerine for an anginal attack is: A. .1-.3 mg. B. .3-.6 mg. C. .6-.9 mg. D. .9-.12 mg.
B
The cardinal sign of left heart failure is: A. diaphoresis. B. dyspnea. C. pitting. D. pulmonary edema.
B
The central zone of ischemia of a CVA is the: A. penumbra. B. core. C. medulla. D. subarachnoid.
B
The highest CAD mortality rates in the United States occur in which ethnic group? A. Caucasian B. African Americans C. Hispanic D. Asians
B
Which area of the brain has pressure placed on it during a subarachnoid hemorrhage? A. Cerebrum B. Cerebellum C. Pons D. Medulla
B
Your patient's blood pressure is 130/84. This is considered: A. normal. B. prehypertension. C. stage I hypertension. D. stage II hypertension.
B
_________________ _________________ is now being used as a common lay term for a CVA to educate the public regarding the seriousness of the condition.
Brain attack
ASA Class III heart failure patients present with fatigue, dyspnea, and orthopnea at all times. Class III heart failure patients present a definite risk and the patient should be treated in a hospital setting. A. The first statement is true; the second statement in false. B. The first statement is false; the second statement is true. C. Both statements are true. D. Both statements are false.
C
All of the following are factors leading to a hemorrhagic CVA EXCEPT: A. substance abuse. B. hypertension. C. atrial fibrillation. D. aneurysm.
C
All of the following are precipitating factors of an anginal attack EXCEPT one. Which one is the exception? A. Exercise B. Full stomach C. Low altitude D. Smoking
C
All of the following are symptoms of heart failure EXCEPT one. Which one is the exception? A. Excessive unexplained weight gain B. Cyanosis of lips and nailbeds C. Prominent carotid artery when patient is sitting upright D. Grayish-blue mucous membranes
C
Heart failure patients being treated in the dental office often require: A. longer appointment times. B. nitrous oxide sedation. C. upright positioning. D. premedication with antibiotics.
C
If an anginal patient is experiencing chest pain that has NOT responded to two doses of nitroglycerine in a 10-minute period the clinician should: A. provide the patient with a double dose of nitroglycerine. B. administer atropine 10 mg IM. C. call 9-1-1. D. none of the above.
C
Individuals suffering from atrial fibrillation are more prone to CVAs due to an increase in: A. aneurysms. B. blood pressure. C. thrombi. D. none of the above.
C
The pathological condition of the myocardium that is reversible and caused by a lack of oxygen to the tissue is" A. CVA. B. myocardial infarction. C. angina. D. pulmonary edema.
C
The pupils of CVA patients are often: A. equal and dilated. B. equal and constricted. C. unequal and dilated. D. unequal and constricted.
C
The type of angina that is referred to as atypical or vasoplastic and occurs spontaneously is: A. stable. B. unstable. C. variant. D. Prinzmetal's.
C
The use of a local anesthetic agent containing epinephrine may cause a significant rise in blood pressure in heart failure patients taking: A. calcium channel blockers. B. diuretics. C. beta-blockers. D. statins.
C
Your patient's blood pressure is 152/96. This is considered: A. normal. B. prehypertension. C. stage I hypertension. D. stage II hypertension.
C
A wax-like substance made in the liver that leads to atherosclerosis is known as _________________.
Cholesterol
The first and MOST important step in the treatment of a suspected CVA would be to _________________ _______________.
Contact 911
A specific sign of a subarachnoid CVA is: A. headache. B. papillary malalignment. C. hypertension. D. neck pain.
D
All of the following are risk factors for a CVA EXCEPT: A. increasing age. B. atherosclerosis. C. black race. D. middle-aged women.
D
All of the following are symptoms of right heart failure EXCEPT one. Which one is the exception? A. Pitting edema B. Distended jugular veins C. Nocturia D. Pulmonary edema
D
All of the following statements describe a bloodless phlebotomy EXCEPT one. Which one is the exception? A. Tourniquets or blood pressure cuffs are applied to three extremities at a time. B. The tourniquet or blood pressure cuff should be tight enough so that an arterial pulse can be felt mesial to the tourniquet/cuff. C. The pressure applied to the cuff should be less than the systolic pressure and greater than the diastolic pressure. D. The cuffs should be placed four inches below the shoulder and six inches above the groin.
D
Atherosclerosis is a common etiology of CVAs due to the formation of: A. thrombi. B. emboli. C. clots. D. all of the above.
D
For a patient experiencing acute pulmonary edema, oxygen should be administered via a non-rebreather bag at a rate of: A. 2-3 liters/minute. B. 4-6 liters/minute. C. 6-8 liters/minute. D. 10 or more liters/minute.
D
MOST new onset coronary artery disease occurs after age: A. 35. B. 45. C. 55. D. 65.
D
The condition that occurs when the heart muscle is impaired and can NO longer pump efficient volumes of oxygenated blood to the body's tissues and organs is: A. hypertension. B. pulmonary edema. C. atherosclerosis. D. heart failure.
D
Which of the following are risk factors for CAD that cannot be changed? A. Gender B. Increased age C. Heredity D. All of the above
D
Which of the following can cause damage to the arterial walls? A. Diabetes B. Tobacco smoke C. High cholesterol D. All of the above
D
Which of the following is an etiology of unstable angina? A. A nonocclusive thrombus on a preexisting plaque B. A coronary spasm C. Inflammation or infection of the heart D. All of the above
D
T/F: All chest pain is cardiac in origin.
F
T/F: Approximately 30% of patients with diabetes die from some form of cardiovascular disease or complication.
F
T/F: CVA is the fifth leading cause of death in the United States with nearly 200,000 new cases per year.
F
T/F: Early morning appointments are recommended for anginal patients as endogenous epinephrine levels peak after this time of day.
F
T/F: Endogenous estrogens seem to negatively affect cardiovascular health.
F
T/F: Heart failure results from almost any kind of cerebrovascular disease.
F
T/F: Individuals suffering from TIAs are less likely to suffer from CVAs.
F
T/F: Ischemic heart disease, commonly angina or myocardial infarction, is the third leading cause of death in the United States.
F
T/F: Right heart failure usually occurs before left heart failure.
F
T/F: The chest pain associated with an anginal attack is often described as sharp and severe.
F
T/F: Thrombolytic agents are the treatment of choice for hemorrhagic CVAs.
F
T/F: Vasoconstrictors in local anesthetics are acceptable to use on patients with unstable angina.
F
The use of _________________ _____________ _______________ in postmenopausal women decreases the risk for CAD
HRT - Hormone replacement therapy
Nitroglycerine is contraindicated in patients with _________________.
Hypotension
The greatest number of deaths in the United States each year occur as a result of complications from _________________ _______________ _______________
IHD - Ischemic heart disease
When a patient presses his or her fist to the sternum it is referred to as the _________________ _______________.
Levine sign
_________________ is a term referring to the damage done to large blood vessels in diabetics as a result of atherosclerosis.
Macroangiopathy
_________________ dilates the coronary blood vessels to decrease cardiac work load in an anginal attack.
Nitroglycreine
The area of ischemic tissue surrounding the core of the CVA is known as the _________________ and is potentially salvageable.
Penumbra
List the signs and symptoms of a cerebrovascular accident and the appropriate treatment for this condition.
Signs and symptoms: - Severe headache - Increased BP - Neck pain or stiffness - Inability to stand or walk - Unequal pupils - Vision changes - Difficulty swallowing - Nausea and vomiting - Facial paralysis - Parasthesia on one side of body - Speech impairment - Altered level of consciousness Treatment: - Position patient semi-upright - Contact EMS - Administer O2 if needed - Monitor vital signs
T/F: African American women have higher CAD mortality rates than non-Hispanic women.
T
T/F: An LDL level of 180 is considered high and places the individual at risk for atherosclerosis.
T
T/F: An increased blood pressure reading is a symptom usually associated with hemorrhagic CVA. True
T
T/F: CAD is the leading cause of death in women in the United States.
T
T/F: Cheyne-Stokes respirations are common with left heart failure due to the increased time it takes for the blood to be circulated from the heart to the brain.
T
T/F: Hemorrhagic strokes have a higher mortality rate than do occlusive strokes.
T
T/F: In individuals over the age of 50, systolic blood pressure is a more important risk factor for cardiovascular disease than diastolic blood pressure.
T
T/F: Patients with stable angina can receive dental care, but should be scheduled for short, minimally stressful appointments.
T
T/F: Patients with unstable angina should only receive emergency dental treatment following consultation with a physician.
T
T/F: Symptoms of left heart failure are MORE prominent at night.
T
T/F: The number of patients suffering from heart failure is increasing as the population is living longer.
T
T/F: Women taking oral contraceptives and diabetics are at higher risk for CVAs.
T