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Dental Management of Cardiac Patients

Posted 05 May 2004 - 09:13 PM (#1) User is offline   Braces 

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1. Infective Endocarditis
  • Definition
  • Incidence and prevalence
  • Etiology
  • Signs and symptoms
  • Classification
  • Medical management
  • Dental management
    a. Prophylactic antibiotic regimens (AB)
    b. Indications for prophylactic AB

2. Rheumatic fever
3. Rheumatic heart disease
4. Heart murmur
5. Congenital heart disease
6. Hypertension
7. Ischemic heart disease
8. Cardiac arrhythmia
9. Congestive heart failure


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Posted 07 May 2004 - 08:11 PM (#2) User is offline   Braces 

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Infective Endocarditis
    Definition
    A disease caused by microbial infection of the heart valves or endocardium most often in proximity to congenital or acquired heart diseases.
    Incidence and Prevalence
  • Patients with previous history has 3-10% risk of another episode
  • Male : female 2 : 1
  • Most common in the age of 30-50 years
  • ↑ Acute cases
  • ↑ Fungal
  • ↑ Gram ve bacteria
  • ↑ with drug addiction
  • ↑ with age ( mitral valve prolapse and systolic hypertension → excessive hemodynamic load placed on abnormal valves → extensive stretching of cusps → loss of valve surface endothelium)
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Posted 09 May 2004 - 05:29 PM (#3) User is offline   Braces 

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Infective Endocarditis
    Etiology
  • Bacteria inters the bloodstream and infects damaged endocardium
  • There should be a host factor
  • 50% of cases caused by staphylococcus aureus
  • 50% involves right side tricuspid valve
  • It might happen to kids under 2 years with no history of cardiac disease
    Manifestations and Diagnosis
  • It manifests in the: skin and mucosa, CNS, kidney, locomotors system, or lungs. Clinical manifestations of infected right side valve differ than left side valve.
  • To be diagnosed as infective endocarditis a triad of: new heart murmur, fever, and +ve culture should be reported.
  • Unexplained fever or multi-system disease is a sign of infective endocarditis.
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Posted 10 May 2004 - 09:11 AM (#4) User is offline   Braces 

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Infective Endocarditis
    Signs
  • Petechia
  • Linear hemorrhage under the nails
  • Oster nods (small, painful, tender, red or purplish nodules)
  • Jane-way lesions (flat, non tender, red spots on palms and soles thatblanch on pressure)
  • Murmurs
  • Anemic pallor
  • Retinal hemorrhage
  • Clubbing of fingers
    1ry Symptoms
  • Weakness
  • Fatigue
  • Arthralgia
  • Weight loss
  • Fever, chills, night sweating
  • Myalgia
    2ry Symptoms Caused By Septic Emboli
  • Paralysis
  • Chest pain
  • Abdominal pain
  • Stiffness
  • Psychiatric manifestation
  • Blindness
  • Hematuria
  • Bone pain
  • Neuralgic symptoms (confusion strokes)
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Posted 10 May 2004 - 09:50 PM (#5) User is offline   Braces 

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Infective Endocarditis

Classification
    Acute
  • Sudden onset
  • Fatal with in 6 weeks
  • Staphylococcus aureus
  • Normal valves involved
    Sub acute
  • Slower onset
  • Fatal with in months
  • Streptococcus viridians
  • Damaged valves involved
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Posted 12 May 2004 - 07:39 AM (#6) User is offline   Braces 

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Infective Endocarditis

Medical Management
    Causative Organism and Treatment
  • Streptococcus viridians
    Penicillin G, 4 million units, IV, every 6 hours + Gentamycin, 1 mg/kg, IV, every 12 hours
  • Staphylococcus aureus
    Nafcillin, 2 g, IV, every 4 hours
  • Candida albicans
    Amphotericin B, variable dose
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Posted 13 May 2004 - 07:10 AM (#7) User is offline   Braces 

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Infective Endocarditis
    Dental treatment that might cause infective endocarditis
  • Periodontal surgery 88%
  • Extraction 51-85%
  • Scaling 8-80%
  • Prophylaxis 0-40%
  • Endo treatment for a non vital tooth 0%
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Posted 21 July 2004 - 08:11 AM (#8) User is offline   Braces 

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Infective Endocarditis
    Antibiotics Work by either of
  • Killing the bacteria
  • Damaging the bacteria
  • Preventing the bacterial adherence to the defective areas of the heart
    Antibiotics Considered when
  • Complication is common but not fatal
  • Complication is rare but has a high mortality rate
  • Single type of organisms are usually involved

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Posted 31 July 2004 - 09:46 AM (#9) User is offline   Braces 

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Infective Endocarditis
    Prophylactic Antibiotic Regimens
  • First drug of choice (oral route)
    Adults Amoxicillin
    3 g, 1 hour before procedure
    1.5 g, 6 hours after initial dose

    Children Amoxicillin
    50 mg/kg, 1 hour before procedure
    1/2 initial dose 6 hours later

    Children <15 kg Amoxicillin
    750 mg, 1 hour before procedure
    1/2 the dose 6 hors later

    Children 15-30 kg Amoxicillin
    1.5 g, 1 hour before procedure
    1/2 the dose 6 hors later

    Children >30 kg Amoxicillin
    3 g, 1 hour before procedure
    1/2 the dose 6 hors later

  • Allergic or long term penicillin
    Adults Erythromycin
    1.5 g, 2 hours before procedure
    1/2 initial dose 6 hors later

    children Erythromycin
    20 mg/kg, 1 hour before procedure
    1/2 initial does 6 hours later

  • Erythromycin intolerance
    Adults Clindamycin
    300 mg, 1hour before procedure
    1/2 initial dose 6 hors later

    Children Clindamycin
    10 mg/kg, 1 hour before procedure
    1/2 initial dose 6 hours later

  • Under GA+ unable to use oral medications
    Ampicillin
    2 g, IV or IM, 30 minutes before procedure
    +
    Amoxicillin
    1.5 g, oral, 6 hours later
    or
    Ampicillin
    1 g, IV or IM, 6 hours later

  • Allergic to penicillin
    Clindamycin
    300 mg, IV, 30 minutes before procedure
    150 mg, oral or IV, 6 hours later

  • For high risk patients (IV route)
    Ampicillin
    2 g, IV or IM 30 minutes before procedure
    +
    Gentamycin
    1.5 mg/kg, IV or IM 30 minutes before procedure

    Amoxicillin
    1.5 g, oral, 6 hours later
    or
    1.5 g, IV, 8 hours later

  • Allergic to penicillin
    vancomycin
    1 g, IV, administered over 1 hour starting 1 hour before procedure, NO repeat dose is necessary

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Posted 05 August 2004 - 11:13 AM (#10) User is offline   Braces 

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Infective Endocarditis

Prophylactic Antibiotic Indications
    High risk patients (AB recommended)
  • Prosthetic cardiac valves (bioprosthetic or homograft)
  • Previous attack of bacterial endocarditis
  • Surgically constructed systemic pulmonary shunts
  • Most congenital cardiac malformation
  • Rheumatic and other acquired valvular dysfunction even after surgery
  • Hypertrophic cardiomyopathy
  • Mitral valve prolaps with regurgitation
    Low risk patients (AB not recommended)
  • Isolated secundum atrial septal defect
  • Previous rheumatic fever with no valvular dysfunction
  • Previous coronary bypass graft surgery
  • Physiologic or functional heart murmur
  • Surgical repair without prosthetic material 6 months or more after surgery
  • Previous kawaskaki disease without valvular dysfunction
  • Mitral valve prolaps without regurgitation
  • Cardiac pacemakers and implanted defibrillators
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Posted 05 August 2004 - 12:19 PM (#11) User is offline   Sub-Zero 

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Salam

thank u braces for this nice piece of work

i have one comment though

QUOTE
First drug of choice (oral route)
Adults Amoxicillin
3 g, 1 hour before procedure
1.5 g, 6 hours after initial dose


what i know is that the lastest accepted dose was 2 grams, 1 hour before procedure
and nothing is given after the procedure

what do u think?

my best regards

bluedot.gif Sub-Zero bluedot.gif


There Is No Knowledge.....
That Is Not Power.....
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Posted 05 August 2004 - 05:00 PM (#12) User is offline   DrReem 

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Prevention of Bacterial Endocarditis

Endocarditis prophylaxis recommended



Prophylactic Regimens for Dental, Oral, Respiratory Tract, or Esophageal Procedures


Situation:
Standard general prophylaxis

Agent:
Amoxicillin

Regimen:
Adults: 2.0 g; children: 50 mg/kg orally 1 h before procedure



----------------------------------------------------------------


Situation:
Unable to take oral medications

Agent:
Ampicillin

Regimen:
Adults: 2.0 g IM or IV; children: 50 mg/kg IM or IV within 30 min before procedure



----------------------------------------------------------------

Situation:
Allergic to penicillin

Agent:
Clindamycin

Regimen:
Adults: 600 mg; children: 20 mg/kg orally 1 h before procedure

or

Agent:
Cephalexin or cefadroxil

Regimen:
Adults: 2.0 g; children; 50 mg/kg orally 1 h before procedure

or

Agent:
Azithromycin or clarithromycin

Regimen:
Adults: 500 mg; children: 15 mg/kg orally 1 h before procedure



----------------------------------------------------------------

Situation:
Allergic to penicillin and unable to take oral medications

Agent:
Clindamycin or Cefazolin

Regimen:
Adults: 600 mg; children: 20 mg/kg IV within 30 min before procedure Adults: 1.0 g; children: 25 mg/kg IM or IV within 30 min before procedure



----------------------------------------------------------------



button2.gif IM indicates intramuscularly, and IV, intravenously.

button2.gif Total children's dose should not exceed adult dose.

button2.gif Cephalosporins should not be used in individuals with immediate-type hypersensitivity reaction (urticaria, angioedema, or anaphylaxis) to penicillins.



Ref: American Heart Association


----------------------------------------------------------------
bluedot.gif http://www.americanheart.org/presenter.jht...ntifier=1200000
----------------------------------------------------------------



SD.gif
Knowledge is Power

When I get older ,
I will be stronger ,
Just like a WAVING FLAG ,
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Posted 05 August 2004 - 05:06 PM (#13) User is offline   Sub-Zero 

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Salam

Thank u Dr.Reem

i think the dose braces mentioned was the old dose

i appreciate the efforts of both braces and Dr.Reem

my regards

bluedot.gif Sub-Zero bluedot.gif


There Is No Knowledge.....
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Posted 06 August 2004 - 08:17 AM (#14) User is offline   Braces 

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U r right Sub-Zero
2 g is the new
AMERICAN prophylactic regimen
Those posts were a book summery thus I did not change anything in it
Though I was mistaken not to mention the new regimen

Btw do not be shocked when u see
BRITHISLY oriented surgeons stick to the old regimen

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Posted 07 August 2004 - 07:28 AM (#15) User is offline   Braces 

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Rheumatic Fever
    Definition
    Acute inflammatory condition that develops in some individuals as a complication following group A streptococcal infection
    It is a childhood disease, 5-15 years
    Signs and Symptoms
  • Major manifestations: arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules
  • Minor manifestations: low grade fever, arthralgia, abnormal erythrocyte sedimentation rate, ECG changes (prolonged PR interval), presence of C-reactive protein
    Diagnoses Based on the Presence of
  • 2 major manifestations and 1 minor
  • 2 minor manifestations,1 major and a history of preceding throat infection with elevation of anti-streptomycin O titer
    Dental Management
    No prophylactic antibiotics are needed
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Posted 18 August 2004 - 02:12 PM (#16) User is offline   Braces 

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Rheumatic Heart Disease
    Definition
    Cardiac damage that results form an acute attack of rheumatic fever usually involves damage of mitral valve or aortic valve causing stenosis or regurgitation
    Signs and Symptoms
  • Murmur may be heard if the valve disease is sufficient
  • Exertional dyspnea, angina pectoris, epistaxis, blood in sputum, congestive heart failure may occur, myocardial hypertrophy, ECG changes (T wave flattening)
    Dental Management
    Prophylactic antibiotic is recommended

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Posted 18 August 2004 - 06:15 PM (#17) User is offline   dr.3 

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Thank you so much Braces flowers.gif

Really it is a good review star.gif

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Posted 19 August 2004 - 12:13 AM (#18) User is offline   Dr_Al_Tuwaijri 

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i'm so impressed mashallah

perfect work braces&dr. Reem

i feel so glad that we have female dr's like u both

very nice topic and very easy to digest and understand

i loved reading it... brief but strong in information

keep the good work..

dr. Johani u did a perfect work in establishing a site like this...

lol.gif Sub-Zero kaifak?? inshallah omourak tamam??? lol.gif

yalla cia bye
When You Are Having A MCQ's Exam, Check The Question Above Where You'll Have The Answer Below
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Posted 19 August 2004 - 12:22 PM (#19) User is offline   Sub-Zero 

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Salam
mashallah its only been a week and u guys have posted alot.. specool.gif
im not quite BACK yet unsure.gif , just wanted to say hi to all of u..
and thanx again for ur efforts DrReem and Braces
dr.3 mashallah 3leek ur posting b-sor3at malyoon post felsa3ah lol tongue.gif



QUOTE
Sub-Zero kaifak?? inshallah omourak tamam???
Dr. Tuwaijri hala 7ayyak, 3loomek?
ga3deen ne7tere ism alketab tongue.gif

Ciao

bluedot.gif Sub-Zero bluedot.gif


There Is No Knowledge.....
That Is Not Power.....
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Posted 19 August 2004 - 01:10 PM (#20) User is offline   Braces 

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Heart Murmur
    Definition
    Nothing more than sound caused by turbulence in the circulation through the valves and chambers of the heart
    Types
  • Innocent or functional: sounds caused by turbulence in the absence of any cardiac abnormalities
  • Organic: sounds caused by pathologic abnormality in the heart
    Dental management
  • Functional murmurs do not require prophylactic antibiotics
  • Organic murmurs do require prophylactic antibiotics

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