Cardiac Emergencies

Cardiac Emergencies- chapter 10-DH 111
IHD- Ischemic Heart Disease-or Myocardial Ischemia: caused by a lack of oxygen
to the heart and surrounding tissues.
Risk Factors: Coronary Artery Disease (Coronary Heart Disease)
1. Gender
6. Cholesterol- hypercholesterolemia
2. Age
7. Diabetes
3. Hereditary
8. Obesity, Lack of physical activity
4. Tobacco Use
5. Hypertension
Angina: Classic characteristic of myocardial ischemia.
Causes: atherosclerosis- a build up of plaque composed of cholesterol,
lipids, platelets, calcium, and cellular debris.
Forms of Angina:
 Stable- typical, chronic, classic, exertional
 Related to coronary artery disease
 Induced by physical activity, stress, cold weather, large meals
 Responds to rest and nitroglycerin
Signs and Symptoms:
o Generalized chest discomfort
o Pressure, burning, heaviness, squeezing, choking
o Cold sweat- diaphoresis
o Nausea
Increased pulse, increased blood pressure
 Unstable- preinfarctory, coronary insuffiency, crescendo angina,
intermediate coronary syndrome, premature or impending MI.
 Imbalance between oxygen supply and demand.
 Nitroglycerin may or may not work. High risk for MI.
 Vasoconstrictors contraindicated.
Signs and symptoms:
o Same as stable, but may occur for no reason
o Intensity more acute
o Longer episode lasting 30 minutes
3 classes of unstable angina:
1. Class I: new onset of severe angina with no pain at rest
2. Class II: subacute angina within past month, but not in preceding
48 hours.
3. Class III: acute angina within 48 hours. Patients should receive only
minimal emergency dental care after a consult with a MD.
 Variant Angina – most likely to occur spontaneously when person is
at rest and odd hours of day or night. Also known as: Prinzmetal’s,
atypical or vasoplastic angina.
 More common in women over 50.
 Caused by a spasm of a coronary artery causing a brief
occlusion of the vessel is thought to start the attack.
 Can occur in patients with out coronary artery disease.
 Nitroglycerin provides prompt relief.
Signs and Symptoms:
o Most likely to occur at rest, associated with
o Palpitations, syncope, and dyspnea- difficulty breathing.
Treatment of Angina: to decrease the hearts need for oxygen
1. Stop dental treatment
2. Set patient upright
3. Assess ABCs
4. Administer oxygen
5. Monitor vitals
6. Give nitroglycerin 0.3-0.6 mg- use patients own medication if available.
One tablet every 5 minutes, up to 3 doses
7. Resume treatment if patient feels better
8. If chest pain not relieved after 2nd dose of nitroglycerin, call 911.
AMI-Acute Myocardial Infarction (heart attack)
- Necrosis of portion of the heart muscle due to total or partial occlusion of a
coronary artery.
- Occlusion caused by atherosclerosis, thrombus or coronary spasm
- MI can lead to cardiac arrest
Signs and Symptoms:
o Classic: chest pain lasting 20 minutes or longer
o Pressure, tightness, heaviness, burning, squeezing, crushing
sensation in middle of chest and lower third of epigastrium
o Pain radiates through arms, shoulders, jaws or back
o Weakness, dyspnea, diaphoresis, nausea, vomiting, irregular
pulse, Levine sign
o Women show different signs- atypical discomfort, upper
abdominal pain, shortness of breath, fatigue
o Elderly- shortness of breath, dizziness, pulmonary edema,
altered mental status
Treatment of AMI in a dental office:
1. Stop dental treatment
7. Give nitroglycerin-3 doses over a 15
2. If no history of angina- call 911
minute period
3. Seat patient comfortably
8. Nitroglycerin should alleviate pain
4. Assess ABCs
within 2-4 minutes
5. Give oxygen
9. Aspirin can be chewed- 162-325 mg
6. Monitor vitals
so it can quickly enter the blood
- Aspirin has an antithrombotic effect and helps revascularize the
myocardium during an ischemic attack.
Full Cardiac Arrest
1. Start CPR
2. Use AED
Best chance for survival if CPR and AED are used in the first 3-5 minutes of cardiac