4. CVD heart failure, valvular heart ds, infectious endocarditis Flashcards
(28 cards)
which ventricle typically fails first in hearth failure
the left ventricle
how to calculate the EF
EF = ejection fraction

normal, borderline and reduced EF
normal is 50 to 70%
borderline is 41 to 49%
reduced is less than 40%
signs of heart failure
- rapid, shallow breathing
- inspiratory rales (crackles)
- incr. heart rate
- distended jugular (neck) veins
- peripheral edema
- ascites
- cyanosis
- weight gain
- clubbing of fingers
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whats this

distended jugular neck vein
a sign of heart failure
whats this

clubbing of fingers
a sign of heart failure
symptoms of heart failure
- fatigue and weakness
- orthopnea (dyspnea in recumbent position)
- exercise intolerance
- muscular fatigue
- feeling heavy (weight gain)
- GI distress (nausea, vomitting and constipation)
stage A
at high risk for HF but WITHOU structural heart ds or symptoms of HF
stage B
structural heart ds but WITHOUT signs or symptoms of HF
stage C
structural heart disease with prior or current symptoms of HF
stage D
refractory HF requiring specialized interventions
does data support or refute efficacy of dental tx (clearance) prior to cardiac surgery
it cannot support or refute
what is the main question to ask when dealing with any pts with heart failure
does the benefit of providing dental tx outweigh the RISK of potential complications
looking into if the heart can or cannot manage the stress of a dental procedure
what kind of detnal care can we do for the following classes of HF
class I
class II
class III
class IV
class I: routine dental care ok
class II: medical consultation required, routine dental care likely ok
class III and IV: consider referral to specialized care
what is valvular stenosis
that they do not open properly
what is valvular insufficiency
that they do not close properly and associated with regurgitation
valvular ds - fibrosis what is it
stiff, sclerosis, stenosis cuasing either stenosis or insufficency
valvular heart disease- myxomatous degeneration
- benign loose CT tumorous changes where valves become floppy, prolapse, regurgitation
- causess insufficiency
signs of valvular heart disease
murmurs
syncope
HF
shortness of breath
symptoms of vavular heart disease
- heart failure
- exercise intolerance
- shortness of breath (can also be a symptom)
medical management of valvular heart ds
tx is primarily surgical, valve replacement (mechanical and bioprosthetic implants), predisposition for infective endocarditis
dental considerations for valvular heart ds
- assess ability to tolerate care in context of underlying condition and comorbidites
- asses bleeding risk- INR, local hemostatic measures in place
- infections - determine need for ab prophylaxis and ab of choice
- drug effects - review med list
what is infective endocarditis
- infection of inner layer of heart usually affects cardiac valves
- was almost always fatal until development of penicillin
- 15,000 cases diagnosed in US each year
- done through blood turbulence within heart allows causative agent to infect previously damaged vales or other endothelial surfaces.
AHA cardiovascular indications for ab prophylaxis:
- prosthetic cardiac valves
- prosthetic material used
- cardiac transplantation with valve regurgitation due to abnormal valve
- prev endocarditits
- CHD
- completely repaire with prosthetic material or device
- reapired CHD with residual shunts or valvular regurgitation
- urepaired cyanotic CHD