Dental patients at risk withDental patients at risk withthe use of epinephrinethe use of epinephrine

HTN CVA ASCAD- MI Cardiac arrythmias hyperthyroid sickle-cell anemia cocaine abuse MAOI

Cardiac arrhythmias- Cardiac arrhythmias- general causesgeneral 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- Cardiac arrhythmias- patient detectionpatient detection

signs: rapid or slow pulse signs: irregular pulse rhythm signs: weak pulse symptoms: palpitations, dizziness, syncope

angina, dyspnea, fatigue

Cardiac arrhythmias-Cardiac arrhythmias-symptomssymptoms

palpitations heart failure fatigue dyspnea dizziness angina syncope

Cardiac arrhythmias-Cardiac arrhythmias-physical signsphysical signs

bradycardia( <60 beats per minute) tachycardia( >100 beats per minute) irregular pulse rhythm ( regular

irregularities, irregular irregularities)

Ectopic beatsEctopic beats

premature atrial beats premature atrio-ventricular beats premature ventricular beats ( PVCs )

most common

Atrial fibrillationAtrial fibrillation

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

emboli

Cardiac arrhythmias-Cardiac arrhythmias-managementmanagement

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-Cardiac arrhythmias-ID patients at riskID patients at risk

HISTORY MEDICATIONS STATUS MONITORING PHYSICAL EVALUATION = signs and

symptoms MEDICAL CONSULTATION

Cardiac arrhythmias-Cardiac arrhythmias-managementmanagement

antiarrhythmic medications ( type, dosage, indications, when adjusted, monitored, etc.)

implanted pacemakers pulse rate, rhythm, character, etc.

Cardiac arrhythmias-Cardiac arrhythmias-medicationsmedications

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 Bleeding problems due to

CoumadinCoumadin

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

Cardiac arrhythmias-Cardiac arrhythmias-managementmanagement

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

Cardiac arrhythmias-Cardiac arrhythmias-ID patients at riskID patients at risk

SYMPTOMATIC Palpitations Dizziness Syncope Angina dyspnea

Cardiac arrhythmias-Cardiac arrhythmias-ID patients at riskID patients at risk

Patients with signs and symptoms: NO TREATMENT! IMMEDIATE REFERRAL FOR

MEDICAL MANAGEMENT

Cardiac arrhythmias-Cardiac arrhythmias-CARDIAC ARRESTCARDIAC ARREST

Ventricular fibrillationprogresses to MI

Ventricular asystoleno conduction

Agonal rhythm conduction

Cardiac arrhythmias-Cardiac arrhythmias-PACEMAKERSPACEMAKERS

Generator Lead electrode

Cardiac arrhythmias-Cardiac arrhythmias-PACEMAKERSPACEMAKERS

Type of pacemaker Type of arrhythmia Degree of shielding Date of / complications from implantation

Cardiac arrhythmias-Cardiac arrhythmias-PACEMAKERSPACEMAKERS

ELECTOMAGNETIC INTERFERENCE Cellular telephone Microwave ovens Electrocautery Ultrasonic scalers Electric pulp testers

Cardiac arrhythmias-Cardiac arrhythmias-PACEMAKERSPACEMAKERS

ELECTOMAGNETIC INTERFERENCE Cellular telephone Microwave ovens Electrocautery Ultrasonic scalers Electric pulp testers

Cardiac arrhythmias-Cardiac arrhythmias-PACEMAKERSPACEMAKERS

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

Cardiac arrhythmias-Cardiac arrhythmias-medications side effectsmedications side effects

Lichenoid reactions Lupus erythematosus lesions Digitalis Quinidine Procainamide

CARDIACCARDIACARRHYTHMIASARRHYTHMIAS

Dr. Nelson L. Rhodus

Distinguished Professor

Director of Oral Medicine

University of Minnesota

BradycardiasBradycardias

sinus bradycardia( normal EKG pattern)<60 BPM

sinoatrial heart block atrioventicular heart block ( AV-1,2,3

degrees)

TachycardiasTachycardias

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)