cardiac failure

Question 1

what is heart failure?

Answer 1

structural and functional problems with cardiac function that prevent blood being adequately pumped round body

Question 2

list the causes of heart failure

Answer 2

-acquired valvular disease or congenital valvular disease
-cardiac arrhythmias
-hypertrophic myopathy
-hypertensive heart disease
-inadequate blood supply to myocardium (MI or ischemic HD)

Question 3

how does heart failure present?

Answer 3

-breathlessness
-cant lie flat (orthopnoea)
-fatigue
-peripheral oedema (fluid accumulation for e.g in lungs or periphery)

Question 4

how would you investigate heart failure?

Answer 4

-ECG
-echocardiogram
-blood tests (BNP hormone increases with HF)
-history/examination

Question 5

how would you treat heart failure?

Answer 5

1- treat the underlying cause e.g hypertension, ischemic HD, arrhythmias
2- medications to treat HF

Question 6

what is the ejection fraction?

Answer 6

the fraction of blood ejected from the ventricles

Question 7

how would you treat heart failure with reduced ejection fraction?

Answer 7

-diuretics
-ace inhibitors
-angiotensin II antagonists
-beta blockers

Question 8

how would you treat heart failure with preserved ejection fraction?

Answer 8

-diuretics

Question 9

what implanted devices are used in heart failure?

Answer 9

-implanted cardioverter defibrillator (defibrillation with arrhythmias)
-cardiac resynchronisation therapy (resynchronises atrial and ventricle contraction) with defib (CRTd) or without defib (CRTp).

Question 10

what should you do if a patient has an implanted device?

Answer 10

check compatibility with dental devices

Question 11

what are the oral side effects of drugs used in heart failure ?

Answer 11

diuretics- xerostomia-increased urination-increased thirst
ace inhibitors- oral lichen and glossitis
angiotensin II antagonists- taste disturbances
beta blockers- xerostomia

Question 12

what are the dental aspects of patients with heart failure?

Answer 12

-avoid treatment if unstable
-polypharmacy (drug interactions)
-postural hypotension (due to drugs used to decrease bp)
-patient may be unable to lie flat and breathless
-check compatibility of equipment if patient has implanted device
-avoid NSAIDS

Question 13

why should patients with heart failure not be given NSAIDS?

Answer 13

they cause fluid retention

Question 14

how would you treat acute heart failure in the surgery?

Answer 14

999- send someone for AED-stay with patient-sit patient into comfortable postion-abcde approach-bls if cardiac arrest-use AED