Diet medications and valvular hearl disease: the current evidence

The patient with a heart murmur: evaluation, assessment and dental considerations

BACKGROUND

Heart murmurs, a common finding in dental patients, are of major concern to dental professionals because certain dental procedures occasionally can induce severe cardiovascular complications. Murmurs may indicate existing heart disease that is a risk factor for infective endocarditis following a dental procedure, as well as more severe heart conditions such as congenital heart disease, atrial fibrillation or congestive heart failure.

TYPES OF STUDIES REVIEWED

This review article is based on data published in peer-reviewed journals, including practice guidelines published by major dental and medical professional organizations.

RESULTS

Echocardiography is the primary means of evaluating heart murmurs, and all dental professionals should become familiar with major aspects of an echocardiogram. Understanding the medical evaluation and assessment of a heart murmur fosters better communication with other health care professionals and results in improved patient care.

CLINICAL IMPLICATIONS

Beyond the need to administer antibiotic prophylaxis, the dentist also needs to address the underlying causes of a patient's heart murmur. By providing dental care to such patients, oral health care providers become part of the patient's overall health care team.

Serotonin and its transporter on proliferation of fetal heart cells

Besides neuronal transmission, serotonin (5-HT) also acts as a trophic signal during the development of the central nervous and neural crest systems. In this study, we report that in addition to trophic effect, 5-HT increases the proliferation of fetal heart cells. We showed for the first time that the cultured heart cells, express serotonin transporter (5-HTT), which confirmed the previously observed accumulation of 5-HT in developing heart. The influence of 5-HT on developing heart cells is studied throughout the dosage. We found that 5-HT concentration at physiological level, 4 microM, permits an optimal proliferation of heart cells as indicated by the number of 5-bromo-deoxyuridine immunoreactive (BrdU-im) cells and myosin heavy chain immunoreactive cells (MF20-im); fluctuation towards either concentrations reduce the proliferation. We hypothesized that 5-HTT plays a role in the heart development. Our study indicated that the blockade of 5-HT uptake by paroxetine decreased the number of BrdU-im cells and MF20-im cells. These data indicate a role of 5-HT and 5-HTT on heart development. Abnormal 5-HT level or misuse of 5-HT uptake blocker may alter the heart development.