5.8 million ppl in US have it Affects 1% of 50 y.o. 5% of 75+ y.o. 25% of 85+ 670,000 diagnosed each year 1 in 5 die within a year of dx Costs the US 40 billion More common in males

type of Left sided Heart Failure Left ventricle doesn't contract normal dilated cavity Age: 50-70 More common in males Ejection Fracture(EF) ≤ 40% common clinical measurement Congestion and Cardiomegaly (enlarged heart) Gallop rhythm in 3rd heart sound reduced pumping of heart HTN, diabetes, sleep apnea-Often Present Obesity & Arterial Fibrillation-sometime present

how much blood is ejected by let ventricle (stroke volume) divide by max volume remaining after diastole Normal \>50% Systolic HF \<40%

Type of Left sided Heart Failure Left chamber doesn't relax normally bc the muscle is stiff (less compliant) and filling is impaired contract normal blocks blood from entering heart back-up into lungs Age: 75+ (elderly) More common in females EF is preserved or \>40% Ventricular hypertrophy present congestion with or w/o cardiomegaly Gallop rhythm on 4th heart sound Obesity, HTN, Diabetes Mellitus-usually present COPD, Sleep Apnea, Hx of dialysis-sometimes Previous Hx of MI and arterial fibrillation-uncommon

Heart Failure Flashcards by Connor Schmidt

What is heart Failure?

the heart is unable to pump efficiently
- can’t pump enough blood to meet oxygen requirements of the body
disproportion b/w hemodynamic demand and capacity of the heart to handle demand

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Heart Failure Stats

5.8 million ppl in US have it
Affects 1% of 50 y.o.
- 5% of 75+ y.o.
- 25% of 85+
670,000 diagnosed each year
- 1 in 5 die within a year of dx
Costs the US 40 billion
More common in males

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Initial Signs of Heart Failure

Unexplained edema (swelling)
Dyspnea (difficult/labored breathing)
Overall sick appearance
Age: 50-70
Wheezing & hoarseness

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Causes of Heart Failure

Acute injury to heart
Chronic Injury to heart

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What acute injuries to the heart can lead to Heart Failure?

Acute injury to heart
- Coronary Heart Disease-leading cause
- Myocarditis
- viral or bacterial infection
- pulmonary embolism

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What chronic injuries to the heart can lead to Heart Failure?

Hypertension
Cardiomyopathy
Valvular heart disease
Congenital heart disease
Pulmonary hypertension
Endocrine thyroid disease

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Chronic Heart Failure

clinical syndrome arising from different causes
Not all pts have low ejection fracture
Types:
- Left sided
- Right Sided

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Left Sided Heart Failure

Types:
- Systolic Heart Failure
- Diastolic Heart Failure

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Left Sided Heart Failure: Symptoms

Restless
Confusion
Pulmonary Congestion:
- Cough
- Crackles
- wheezes
- blood-tinged sputum
- Tachypnea
Orthopnea
- discomfort when breathing while lying down
Paroxysmal Nocturnal Dyspnea
- short of breath while sleeping-wakes them up
Exertional Dyspnea
- short of breath during exercise
Tachycardia
Fatigue
Cyanosis
- blue skin
Elevated Pulmonary Capillary Wedge Pressure

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Systolic HF

type of Left sided Heart Failure
Left ventricle doesn’t contract normal
- dilated cavity
Age: 50-70
More common in males
Ejection Fracture(EF) ≤ 40%
- common clinical measurement
Congestion and Cardiomegaly (enlarged heart)
- Gallop rhythm in 3rd heart sound
- reduced pumping of heart
HTN, diabetes, sleep apnea-Often Present
Obesity & Arterial Fibrillation-sometime present

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Ejection Fraction

how much blood is ejected by let ventricle (stroke volume)
- divide by max volume remaining after diastole
Normal >50%
Systolic HF <40%

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Diastolic HF

Type of Left sided Heart Failure
Left chamber doesn’t relax normally bc the muscle is stiff (less compliant) and filling is impaired
- contract normal
- blocks blood from entering heart
  - back-up into lungs
Age: 75+ (elderly)
More common in females
EF is preserved or >40%
Ventricular hypertrophy present
- congestion with or w/o cardiomegaly
- Gallop rhythm on 4th heart sound
Obesity, HTN, Diabetes Mellitus-usually present
- COPD, Sleep Apnea, Hx of dialysis-sometimes
- Previous Hx of MI and arterial fibrillation-uncommon

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Right Sided Heart Failure: symptoms

Fatigue
Increased Peripheral Venous Pressure
Ascites-abdominal swelling
Enlarged liver and spleen
might be secondary to chronic pulmonary problems
Distended jugular veins
Anorexia
Complains of GI distress
Weight Gain
Dependent Edema

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Chronic Heart Failure: Diagnosis

BNP Blood Test
- Normal <100
- HF is present: 100-300
- Mild HF: above 300 (301-600)
- Moderate HF: above 600 (601-900)
- Severe HF: above 900
Electrocardiogram (ECG)
Chest X-ray
Echocardiogram

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Chronic Heart Failure Lab findings: (NOT BNP)

Polycythemia, thrombocytopenia, leucopenia
Depleted Coagulation factors
Urnie analysis
- proteinuria
- increased specific gravity
Abnormal Liver Function

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New York Heart Association (NYHA) Classification

Class 1
- Mild
  - no limit on physical activity
- Normal Physical activity does not cause
  - fatigue, palpitation, or dyspnea (Short of breath)
Class 2:
- Mild
  - slight limit on physical activity
- Comfortable at rest
  - but normal physical activity causes fatigue, palpitation, or dyspnea
Class 3
- Moderate
  - marked limit on physical activity
- Comfortable at rest but
  - less than normal activity causes f, p, or d
Class 4:
- Severe
  - can’t do any physical activity without discomfort
- At rest-cardiac insufficiency symptoms

Hearts Compensatory Mechanism to Heart Failure

Tachycardia
- decrease of cardiac output causes increase in heart rate
Fluid retention
- decreased renal perfusion(less blood to kidneys)→increased renin secretion by kidneys→Increased levels of Angiotensin II→generalized vasoconstriction and promotes fluid retention
Myocardial Hypertrophy

Chronic Heart failure Progression

Failed compensatory mechanism causes inadequate CO
FINISH

CHF Treatment

Life style modification
- lose weight, reduce salt intake, stop smoking, restrict alcohol, aerobic exercises
if CHF due to:
- inadequate blood flow to heart muscle→restore blood flow
  - coronary artery surgery
  - catheter procedures (angioplasty, intracoronary stenting)
- severe disease of valve→valve surgery
- Chronic, uncontrolled HTN→aggressive BP control
- Severe alcohol abuse→stop drinking
Medications
VADs (ventricular assist device)
- LVAD
IABP (intra-aortic balloon pump)
Heart Transplant

CHF Medications

Ace Inhibitors
Angiotensin receptor blockers (ARBs)
Beta Blockers
Digoxin
Diuretics

VADs

Ventricular Assist Device
improves pumping
LVAD
- left ventricular assist device
- pt w/bradycardia

IABP

maintain heart function in left-side heart failure who are waiting for:
- transplant
- develop deterioration of heart function

CHF Oral Manifestations

Infection
Bleeding
Petechiae
Ecchymoses
Drugs related oral dryness
Lichenoid mucosal lesions

CHF: Potential problems related to dental care

Sudden death from cardiac arrest
Arrhythmia related death
Cerebrovascular accident
Breathing difficulty
Drug Side effects
- Orthostatic hypotension
  - diuretics
  - vasodilators
- Arrhythmias
  - digoxin overdose
- Nausea & vomiting
  - digoxin
  - vasodilators
- Palpitations
  - vasodilators

Steps to take to prevent medical emergency in dental setting

* No routine dental care until patient is under good medical management * cause of HF and any complications must be controlled * Short Appointments * Pt should be relaxed * Avoid elective procedures in stage 3 or 4 patients * Local anesthetics w/vasoconstrictors * avoid or use minimally

How to prevent complications

* Assess for adverse events from medications * Digitalis * pt more prone to Nausea and vomitting * Certain meds should be minimized/avoided * **especially for drugs that cause sodium retention or affect the power of the heart muscle** * NSAIDs * ibuprofen * naproxen

Digoxin

* Record base line pulse rate and rhyme * use Epinephrine & Anticholinergic w/caution * Avoid Tetracycline & Macrolide * result in increased serum conc. of digoxin

Non-selective Beta Blockers

* Epinephrine * can cause acute hypertensive effect * NSAIDs for 5+ days diminish effect

Calcium Channel Blockers

* Verapamil & Diltiazem * compete w/macrolide antibiotics for metabolizing enzymes

Diuretics

* use of NSAIDs for 5+ days diminish use

ACE Inhibitors

use of NSAIDs for 5+ days diminish use

ARBs

use of NSAIDs for 5+ days diminish use