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

2. 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

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

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

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

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

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

8. 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.)

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

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

11. 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

12. Bleeding problems due to Coumadin 10-40 % of hospital admissions for bleeding age-dependent strength and duration of coumadin Rx reduction of bleeding with proper anticoagulant monitoring guideline-based recommendations

13. 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)

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

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

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

18. Cardiac arrhythmias- PACEMAKERS Generator Lead electrode

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

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

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

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

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

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

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

29. Tachycardias sinus tachycardia ( >100 per minute) atrial tachycardia ( >150-200 per minute) atrial flutter ( >220-360 per minute) atrial fibrillation ( >400-650 per minute) ventricular tachycardia ( 3 or more at >100 per minute)