Dental patients at risk with the use of epinephrine HTN CVA ASCAD- MI Cardiac arrythmias hyperthyroid sickle-cell anemia cocaine abuse MAOI

Cardiac arrhythmias- general causes ASCAD other CVD( CHD, MI, CHF, RHD, etc.) pulmonary (COPD) autonomic disorders thyroid disease medical-systemic diseases drug side effects electrolyte imbalances

Cardiac arrhythmias- patient detection signs: rapid or slow pulse signs: irregular pulse rhythm signs: weak pulse symptoms: palpitations, dizziness, syncope angina, dyspnea, fatigue

Cardiac arrhythmias- symptoms palpitations heart failure fatigue dyspnea dizziness angina syncope

Cardiac arrhythmias- physical signs bradycardia( <60 beats per minute) tachycardia( >100 beats per minute) irregular pulse rhythm ( regular irregularities, irregular irregularities)

Ectopic beats premature atrial beats premature atrio-ventricular beats premature ventricular beats ( PVCs ) most common

Atrial fibrillation very common may or may not be serious irregular ventricular response poor atrial transport emboli

Cardiac arrhythmias- management ID patients, physical status, risk assessment other CVD ( i.e. ASCAV, CHF, RHD, MI, CHF, etc.) other medical-systemic ( thyroid, COPD, MAOI, etc.)

Cardiac arrhythmias- ID patients at risk HISTORY MEDICATIONS STATUS MONITORING PHYSICAL EVALUATION = signs and symptoms MEDICAL CONSULTATION

Cardiac arrhythmias- management antiarrhythmic medications ( type, dosage, indications, when adjusted, monitored, etc.) implanted pacemakers pulse rate, rhythm, character, etc.

Cardiac arrhythmias- medications Digoxin-slows conduction in the A-V node Digitoxin- same- more powerful quinidine- depresses ectopic procainamide- ventricular arrhythmias verapamil- regulates Ca++ in slow channels sotalol/propanolol- beta-blokers disopyramide- depresses automaticity lidocaine- emergency Tx

Bleeding problems due to Coumadin % of hospital admissions for bleeding age-dependent strength and duration of coumadin Rx reduction of bleeding with proper anticoagulant monitoring guideline-based recommendations

Cardiac arrhythmias- management Close monitoring: vital signs: HR & rhythm Stress-anxiety reduction Open-honest communication Short-non-stressful appointments Limit/avoid epinephrine Premedication( daizepam, N2O2)

Cardiac arrhythmias- ID patients at risk SYMPTOMATIC Palpitations Dizziness Syncope Angina dyspnea

Cardiac arrhythmias- ID patients at risk Patients with signs and symptoms: NO TREATMENT! IMMEDIATE REFERRAL FOR MEDICAL MANAGEMENT

Cardiac arrhythmias- CARDIAC ARREST Ventricular fibrillation progresses to MI Ventricular asystole no conduction Agonal rhythm conduction

Cardiac arrhythmias- PACEMAKERS Generator Lead electrode

Cardiac arrhythmias- PACEMAKERS Type of pacemaker Type of arrhythmia Degree of shielding Date of / complications from implantation

Cardiac arrhythmias- PACEMAKERS ELECTOMAGNETIC INTERFERENCE Cellular telephone Microwave ovens Electrocautery Ultrasonic scalers Electric pulp testers

Cardiac arrhythmias- PACEMAKERS ELECTOMAGNETIC INTERFERENCE Cellular telephone Microwave ovens Electrocautery Ultrasonic scalers Electric pulp testers

Cardiac arrhythmias- PACEMAKERS Symptomatic sinus bradycardia Symptomatic A-V block( 1,2,3) Tachycardias refractory to Rx therapy

Cardiac arrhythmias- medications side effects Lichenoid reactions Lupus erythematosus lesions Digitalis Quinidine Procainamide

CARDIAC ARRHYTHMIAS Dr. Nelson L. Rhodus Distinguished Professor Director of Oral Medicine University of Minnesota

Bradycardias sinus bradycardia( normal EKG pattern) <60 BPM sinoatrial heart block atrioventicular heart block ( AV-1,2,3 degrees)

Tachycardias sinus tachycardia ( >100 per minute) atrial tachycardia ( > per minute) atrial flutter ( > per minute) atrial fibrillation ( > per minute) ventricular tachycardia ( 3 or more at >100 per minute)