Congestive Heart Failure Flashcards
Congestive Heart Failure
- inability of heart to supply enough blood circulation to meet the body’s needs
- 80% of patients diagnosed are over 65 yrs old
- untreated/poorly controlled CHF: high risk for complications during dental procedures (MI, stroke)
Causes
Coronary heart disease, cardiomyopathy, HTN, IE, Pulmonary hypertension, PE
Pathophysiology
Inability of heart to pump effectively
Decrease cardiac output, systemic conogestion
Left vs Right Sided Heart Failure
LVHF (most common)
- caused by HTN (increased workload) or cardiomyopathy
- eventually leads to RVHF
RVHF
- most commonly caused by LVHF
- pure RVHF = cor pulmonale = due to emphysema
- problem with venous return, results in systemic venous congestion, peripheral edema
Signs/Symptoms
- # 1 dyspnea (congestion of pulmonary vessels)
- Fatigue
- Peripheral edema
- Clubbing of the fingers
- Distended veins (esp neck)
- Ascites (distended stomach)
- Large, tender liver (liver congestion)
- Enlarged heart on chest radiograph
Medical Management
Diuretics (thiazides, loop/furosamide)
ACEI (prils)
Angiotensin receptor blocker (sartans)
Aldosterone inhibitor (spironolactone)
Beta blockers
Vasodilators (hydralazine)
Dental Management
Dental tx: No modification if CHF well controlled
Abx prophy: NO
BP: emergency if BP below 100/60
NSAIDS: Avoid! Can cause fluid retention (prostaglandin renal-protective: increase GFR)
EPI: 2 carp
Bleeding: anticipate due to coumadin, plavix
Chair: may be unable to fully recline