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Medical Emergencies > Chapter 11: HF/Acute Pulmonary Edema > Flashcards

Chapter 11: HF/Acute Pulmonary Edema Flashcards

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USMLE® Step 1 flashcards
1
Q

How many people suffer from heart failure in the US and why is it rising?

A

5 million;

Number is rising due to aging population and MI survival

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2
Q

When is heart failure and what is its etiology?

A

Occurs when heart muscle is impaired and no longer pumps sufficient blood to body tissues and organs;
Can result from almost any kind of CVD;
MI and hypertension are most frequent etiology;
Also associated with thyroid disease, renal insufficiency, and pulmonary disease

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3
Q

When does heart failure usually occur?

A

Initially presents during exertion;

As disease progresses, symptoms occur even when at rest

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4
Q

How does the dental setting affect heart failure?

A

Physiological and psychological stress exacerbate symptoms;

Can lead to pulmonary edema

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5
Q

What are the clinical manifestations of HF?

A

Left ventricular HF
Right ventricular HF
Both left and right ventricular HF

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6
Q

What is left ventricular HF?

A

Inability of the left ventricle to pump blood to the body tissues;
Results in a fall in CO;
Usually occurs before right ventricular HF;
Blood coming to left ventricle may back up causing fluid to leak into lungs (pulmonary edema)

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7
Q

What are the signs and symptoms of Left HF?

A

Classic: dyspnea
Tachypnea
Increased depth
Non-productive, dry cough due to lung congestion
Cardiac asthma(congestion of bronchial mucosa–>wheezing)
Pale and cool to touch
Diaphoresis
Increased BP
Pulse rapid and thready (may alt between strong and weak)
Pulsus alternans
Weakness and fatigue

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8
Q

When are symptoms of left HF more prominent and why?

A

At night (paroxysmal nocturnal sleep);
while patient is supine (orthopnea)
head needs to be elevated

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9
Q

What ASA are heart failure patients and what may they require?

A

ASA III or IV;

Often require supplemental oxygen via nasal cannula

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10
Q

What are the signs and symptoms of right heart failure?

A 
Usually develops after left HF;
Classic: peripheral edema with pitting
Fatigue and weakness
Pitting edema in lower legs and ankles
Distended jugular vein
Nocturia
Nausea
Vomiting
Anorexia
Headaches
Insomnia
Irritability
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11
Q

Right heart failure results in…

A

Inability of the heart to pump blood from the systemic circulation to the lungs;
Congestion in systemic venous system;
Reduction in renal blood flow–>retention of fluid

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12
Q

What happens if the patient has reduction in renal blood flow due to right heart failure?

A

During the day, patient’s activity increases degree of HF–>less urine production;
At night, patient is less active–>renal and cardiac function may improve (nocturia may result–>increased urination at night

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13
Q

Signs and symptoms of later stages of HF

A

Edema in abdomen
Mental confusion, anxiety, and restlessness–>lack of oxygen to brain
Cardiac cachexia-wasting of tissues
Cyanosis of skin, mucous memb, nail beds, lips

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14
Q

Classification of heart failure

A

Stages A&B: no signs or symptoms, but are at risk due to risk factors or heart abnormalities
Stage C: current or past symptoms
Stage D: refractory heart failure–>eligible for advanced treatment and/or transplantation

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15
Q

What are the treatments for heart failure?

A

Lifestyle changes can lessen symptoms

Drug therapy

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16
Q

What are the lifestyle changes that can lessen HF symptoms?

A 
Smoking cessation
Exercise
Weight loss
Limit consumption of caffeine and alcohol
Reduce stress
17
Q

What are the drug therapies for HF?

A 
ACE inhibitors
Diuretics
Vasodilators
Beta blockers
Calcium channel blockers
18
Q

What questions do you ask a patient to check for current HF?

A

Heart failure
Swelling in feet or ankles
Shortness of breath
Weight gain–>3 pounds over 7 days with edema***red flag- postpone treatment

19
Q

What are the physical characteristics observed in the dental setting indicating heart failure?

A

Cyanosis
Jugular veins
Vital signs prior to treatment and throughout appointment

20
Q

How is an ASA II patient managed in the dental setting?

A

(mild dyspnea and fatigue during exertion)
May need supplemental oxygen, 3-5L/min via nasal cannula
Chair more upright position

21
Q

How do you manage an ASA III patient?

A 
(mild dyspnea and fatigue under normal conditions)
Require medical consultation
Orthopnea s concern
Modification in patient positioning
Supplemental oxygen
22
Q

What are the symptoms and how do you manage an ASA IV patient?

A

(dyspnea, orthopnea, and fatigue at all times)
Require medical consultation
Elective treatment should be postponed until symptoms are controlled

23
Q

What is Acute Pulmonary Edema?

A

Most dramatic life-threatening symptom of left HF
Inhibits lung expansion
Decreased ability of lungs to oxygenate blood

24
Q

What are the precipitating events of Acute Pulmonary Edema?

A

Stress
Infection
Failure to take medications as prescribed
Meal high in sodium

25
Q

What are the signs and symptoms of Acute Pulmonary Edema?

A 
Gasping for air
Rapid pulse
Cool, moist skin
Cyanotic lips and nail beds
Anxiety
Dyspnea with cough that may produce frothy, blood tinged sputum
Loud course lung sounds
26
Q

What are the basic treatments for Acute Pulmonary Edema?

A

Focus on reduction of fluids in lungs
Sitting patient upright redirects blood to lower extremities and relieves pressure on lungs
Drug therapy: diuretics, vasodilators
Oxygen
Severe cases may need to be intubated and ventilated mechanically in a hpspital

27
Q

What is the treatment protocol of Acute pulmonary edema in the dental setting?

A

Life threatening
Call EMS
Terminate all treatment
Reduce patient anxiety to reduce cardiac and respiratory workload
Position patient comfortably, usually upright to aid breathing
ABC’s
Oxygen at 10L/minute
Monitor vital signs every 5 minutes
Nitroglycerin 2-3 tablets/sprays every 5-10 minutes (do not use if systolic BP < 100mmHg
If consciousness is lost, place in supine and start CPR

28
Q

What do can you do if dyspnea continues in a patient experiencing acute pulmonary edema?

A

Perform bloodless phlebotomy:
Place 3 tourniquets or BP cuffs on 3 limbs (6 inches below groin/4 inches below shoulder) tight enough to reduce blood flow, but loose enough to maintain arterial pulse
Remove one tourniquet at a time every 5-10 minutes and reapply to free extremity

29
Q

What does bloodless phlebotomy do?

A

Removes blood from circulation permitting heart to pump remaining blood more effectively
Results in reduction in pulmonary congestion and improves breathing

30
Q 
1. Left ventricular HF results in
A. respiratory distress
B. peripheral edema
C. distended jugular while lying or sitting
D.  Nocturia
A

A. respiratory distress

31
Q
  1. All of the following symptoms are observed in late stage heart failure except one. Which symptom is the exception?
    A. cyanosis of the lips and/or nail beds
    B. cardiac cachexia
    C. mental confusion and anxiety
    D. stabbing chest pain lasting less than 30 seconds
A

D. stabbing chest pain lasting less than 30 seconds

32
Q
  1. Right ventricular heart failure usually develops before left ventricular heart failure. The major clinical symptom of RV heart failure is pulmonary edema.
    A. The first statement is true, the second statement is false.
    B. The first statement if false, the second statement is true.
    C. Both statements are true.
    D. Both statements are false.
A

D. Both statements are false.

33
Q
  1. When providing elective dental treatment, supplemental oxygen and modification of patient positioning should be considered for all of the following except one. Which one is the exception?
    A. ASA II heart failure patients
    B. ASA III heart failure patients
    C. ASA IV heart failure patients
A

C. ASA IV heart failure patients

34
Q
  1. A bloodless phlebotomy
    A. should only be performed in a hospital setting on patients suffering from heart failure.
    B. could be performed in the dental setting to help reduce peripheral edema in heart failure patients.
    C. could be performed in a dental setting to help manage lung congestion in patients suffering from acute pulmonary edema.
    D. Is never a treatment option for patients experiencing Acute pulmonary edema.
A

C. could be performed in a dental setting to help manage lung congestion in patients suffering from acute pulmonary edema.

35
Q

The administration of nitroglycerin is indicated in the management of acute pulmonary edema and heart failure. The administration of nitroglycerin is contraindicated in patients with a systolic pressure less than 100mmHg.
A. The first statement is true, the second statement is false.
B. The first statement if false, the second statement is true.
C. Both statements are true.
D. Both statements are false.

A

B. The first statement if false, the second statement is true.

Medical Emergencies (3 decks)

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