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Systemic Disease in Dentistry > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure?

A

The state in which the heart is unable to pump blood at a rate commensurate with requirements of the tissues or can only do so from high pressures`

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2
Q

What are 4 reasons cardiac failure may be important with regards to dentistry?

A
  1. Common and potentially serious condition
  2. Treatments may impact dental procedures
  3. Dental problems may affect cardiac function
  4. Patients may mention symptoms to be aware of
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3
Q

Describe the prevalence of heart failure in the UK

A
  • Around 550,000 people in the UK with heart failure
  • Prevalence fairly steady but gradually increasing
  • Increasing due to people surviving more complex heart conditions
  • Older population more affected
  • Survival from myocardial infarction has increased risk of failure
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4
Q

Describe 4 things needed for a functioning heart

A
  1. Healthy muscle with healthy blood supply
  2. Intact valves
  3. Intact vessels
  4. Intact cardiac cycle
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5
Q

What is HFrEF?

A
  • Systolic HF
  • Reduced systolic function i.e blood ejected in each systolic contraction is reduced as heart muscle cannot squeeze as well
  • EF < 40%
  • Target of majority of therapies
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6
Q

What is HFpEF?

A
  • Diastolic failure
  • Cardiac muscle will not allow the heart to fill properly, usually due to hypertrophy of the muscle
  • EF > 50%
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7
Q

Describe 4 common causes of heart failure

A
  1. Coronary artery disease (70% cases)
  2. Hypertension
  3. Vascular disease
  4. Diabetes Mellitus (cardiomyopathy and progression of CAD)
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8
Q

What is myocarditis?

A

Acute inflammation of heart caused by viral factors

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9
Q

Name 5 uncommon causes of heart failure

A
  1. Myocarditis
  2. Congenital heart defects
  3. Tachyarrhythmia
  4. Cardiomyopathy
  5. Chronic disease
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10
Q

Describe 4 components of the presentation of heart failure

A
  1. Dyspnoea
  2. PND (specific form of dyspnoea)
  3. Swelling / Dependent oedema
  4. Fatigue / Weight gain
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11
Q

Describe 3 pulmonary clinical findings of heart failure

A
  1. Respiration distress
  2. Crepitations (cracking on breathing)
  3. Wheeze
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12
Q

Describe 5 cardiac clinical findings of heart failure

A
  1. Bradycardia / Tachycardia
  2. Displaced apex beat
  3. Raised JVP
  4. Extra heart sounds
  5. Murmurs
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13
Q

Describe 2 clinical findings of heart failure in the abdomen

A
  1. Ascites

2. Hepato-jugular reflux

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14
Q

Describe 4 clinical findings of heart failure in extremities

A
  1. Cool
  2. Dependent oedema
  3. Cyanosis
  4. Pallor
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15
Q

Describe the 5 main clinical findings of right sided heart failure

A
  1. Oedema
  2. Ascites
  3. Pleural effusions
  4. Raised JVP
  5. Hepatomegaly
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16
Q

Describe 3 main clinical findings of left sided heart failure

A
  1. Pulmonary oedema
  2. Low blood pressure
  3. Fatigue
17
Q

Describe why pulmonary oedema occurs in heart failure

A
  • Increased LV diastolic pressure, increased LA pressures and increased pulmonary venous and capillary pressures
  • Pulmonary capillary pressure exceeds oncotic pressure
  • Fluid enters the alveoli
18
Q

Describe 5 patient symptoms of pulmonary oedema

A
  1. Fighting for breath
  2. Distressed, clammy and cyanosed
  3. Rapid respiratory rate
  4. Profuse frothy pink sputum
  5. Crepitations and rhonchi
19
Q

What is orthopnoea?

A

Breathlessness on lying down due to increased venous return

20
Q

What is paroxysmal nocturnal dyspnoea?

A

Due to fluid shifts from interstitial tissues to circulation whilst laying down resulting in pulmonary oedema

21
Q

Describe NYHA classification of heart failure

A

Class I - No limit on physical activity
Class II - Comfortable at rest with slight limitation of physical activity
Class III - Comfortable at rest with marked limitation and discomfort on less than ordinary activity
Class IV - Discomfort at rest

22
Q

Describe 5 complications of heart failure

A
  1. Renal failure
  2. Impaired liver function
  3. Thrombo-embolism
  4. Ventricular arrhythmias
  5. Sudden death
23
Q

Describe 5 components of diagnosis of heart failure

A
  1. ECG is mandatory
  2. Chest X-Ray
  3. Laboratory testing
  4. Echocardiography
  5. MRI
24
Q

Describe 4 things to look for chest x-rays

A
  1. Pulmonary venous congestion
  2. Interstitial oedema
  3. Cardiomegaly
  4. Pleural effusions
25
Q

Describe lifestyle management of cardiac failure

A
  • Vaccinations against flu and pneumococcal infections
  • Alcohol and tobacco cessation
  • Weight management
  • Avoidance of contra-indicated medication
  • Fluid management
26
Q

Describe 2 drugs which improve symptoms of heart failure

A
  1. Diuretics

2. Digoxin

27
Q

Describe 5 types of drugs which improve survival of heart failure

A
  1. B-blockers
  2. Ivabradine
  3. ACE inhibitors
  4. Aldosterone blockers
  5. ARBs
28
Q

Describe, basically, how ACE inhibitors, aldosterone blockers and ARBs improve survival of patients with heart failure

A

Knock out steps in renin-angiotensin system to prevent production of AT1 and AT2

29
Q

Describe ACE inhibitors as a therapy for heart failure

A
  • First line therapy in all patients
  • Initial therapy in absence of fluid retention
  • Initiate even in transient heart failure post MI
  • Titrate doses to maximum and not based on symptoms
30
Q

Describe ARBs as a therapy for heart failure

A
  • Alternative to ACE inhibitors in symptomatic patients intolerant to ACE inhibitors
  • Similar effect to ACE inhibiors
  • Used in MI with heart failure or LV dysfunction
31
Q

Name 2 aldosterone antagonists

A
  1. Spironolactone

2. Eplerenone

32
Q

Name 2 side effects of aldosterone antagonists

A
  1. Hyperkalaemia

2. Renal dysfunction

33
Q

Describe beta blockers as a treatment for heart failure

A
  • Recommended for all patients NYHA II - NYHA IV on standard treatments
  • Reduce mortality in LV systolic dysfunction post MI
34
Q

Describe ivabradine as a therapy for heart failure

A
  • Only used in SR

- Used in heart failure if beta blocker contra indicated or if on maximum dose of B-blocker

35
Q

Describe digoxin as a therapy for heart failure

A

Symptom relief in absence of arrhythmias

36
Q

Describe 3 indications for cardiac resynchronisation therapy

A
  1. Moderate to severe CHF who have failed optimal medical therapy
  2. EF < 30%
  3. Evidence of electrical conduction dleay
37
Q

Describe 4 ways to treat acute heart failure

A
  1. Oxygenation and fluid restriction
  2. Diuretics if fluid overloaded
  3. IV nitrates if blood pressure stable with vasodilator
  4. Inotropes to improve cardiac output

Systemic Disease in Dentistry (22 decks)

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