3BDS: CVD 5

which side of the heart is most commonly affected by valvular heart disease

left: aortic and mitral valve

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what is the aetiology of Valvular heart disease

- congenital
- infective endocarditis
- rheumatic fever (complication of streptococcus infection often in children, increasingly rare)
- age related (most common

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what is the pathophysiology of valvular heart disease? what is wrong with the valve

1. Regurgitation
• Loss of valve integrity
• Becomes ‘floppy’
• Leaks
Instead of being closed- floppy and leaks
Leads to heart failure as the blood flowing the way it should it regurgitates back into the chamber it came from
2. Stenosis (it doesn’t open

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what is the treatment for valvular heart

Medication (treat heart failure)
Surgery (treatment of choice)

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what surgery can be done for someone with valvular heart disease

a. open heart surgery valve replacement
- Biological like porcine- may need short term post op anticoagulation
- Mechanical- always need lifelong anticoagulation with warfarin
b. Transcatheter aortic valve implantation (TAVI)- biological valve so no warf

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what are the dental aspects when it comes to someone with valvular heart disease

• Anticoagulation
Warfarin and other anticoagulants
INR for metal valves usually >3 (2.5-4.0 depending on valve and patient factors)

• Risk of infective endocarditis
Can be induced by invasive procedures (including tooth brushing)
Can occur spontaneou

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what is INR

how long it takes for a clot to form in a blood sample.

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What does a high and low INR mean

A result of 1.0, up to 1.5, is therefore normal. A low INR result means your blood is 'not thin enough' or coagulates too easily and puts you at risk of developing a blood clot. A high INR result means your blood coagulates too slowly and you risk bleedin

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what are some of the congenital heart disease

atrial septal defect, ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, tetralogy of fallot

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what is atrial septal defect.
is someone with this at risk of IE

Hole in septum between right and left atrium
Blood pressure in left atrium is higher than right and can cause a shunt of blood from left side of heart to the right atrium
NO

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What is ventricular septal defect ?
is someone with this at an increased risk of IE?

Hole in ventricular septum (septum between left and right ventricle. Same as above, mixing of oxygenated into deoxygenated blood) fast shunt and very high pressure
YES

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What is patent ductus arteriosus?
is someone with this at an increased risk of IE?

Aorta and pulmonary artery abnormal connection. Remnant of embryology, foetal blood blow
Ductus arteriosus is part of foetal circulation. Usually closes and birth if it doesn’t, it causes a shunt from aorta into pulmonary artery. Left to right shunt
YES

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What is coarctation of the aorta?
Is someone with this at an increased risk of IE

Narrowing of aorta at site of embryonic ductus arteriosus
YES

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What is tetralogy of fallot
Is someone with this at an increased risk of IE

Complex congenital/ embryological cardiac condition. defects listed below:
VSD
Pulmonary stenosis
RV hypertrophy
Over- riding aorta
YES

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What are the dental aspects when it comes with to someone with congenital heart disease

Risk of IE unless it is an isolated atrial septal defect
If severe, can have problems lying flat
Seek advice from cardiologist if unsure how to proceed
Dental treatment in hospital in those with cyanotic heart disease advised

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where does infective endocarditis occur and due to what bacteria

• Usually occurs on diseased or prosthetic valves
Due to bacteraemia
- Strep viridans (oral commensal )
- Strep faecalis (bowel commensal)
- Staph. Aureus (including MRSA)

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what are some of the clinical features of IE

Prolonged febrile illness, valve degeneration and failure, embolic disease (brain, skin, anywhere), immune complex formation (kidney failure.)
Swinging fever, incompetent valve- heart failure
Vegetation can go to other parts of body

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what is the treatment for IE

prolonged course of intravenous antibiotics (4 weeks or more), surgery may be necessary

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what would make a patient at higher risk of IE

• Acquired valvular heart disease with stenosis or regurgitation
• Valve replacement
• Hypertrophic cardiomyopathy
• Previous endocarditis
• Structural congenital heart disease (including surgically corrected structural conditions but excluding isolated

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What are the dental aspect if a patient has valvular heart disease

-maintain high standards of oral hygiene (avoid surgery if possible, minimise risks if surgery necessary), avoid spontaneous bacteraemia
-prophylaxis no longer routinely given

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what are the special considerations of prophylaxis

+ patients with a previous episode of IE
+patients with any prosthetic valve, including trans catheter valve or those in whom any prosthetic material was used for cardiac valve repair
+patients with congenital heart disease. (any type of cyanotic congenit

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what antibiotics to use if prophylaxis is required?

if no penicillin allergy, monitor INR if on warfarin, risk of clostridium difficile= amoxicillin

if known penicillin allergy, risk of clostridium difficile= clindamycin

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3BDS: CVD 5

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