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Week 77 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart Failure?

A
  • 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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2
Q

Heart Failure Stats

A
  • 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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3
Q

Initial Signs of Heart Failure

A
  • Unexplained edema (swelling)
  • Dyspnea (difficult/labored breathing)
  • Overall sick appearance
  • Age: 50-70
  • Wheezing & hoarseness
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4
Q

Causes of Heart Failure

A
  • Acute injury to heart
  • Chronic Injury to heart
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5
Q

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

A
  • Acute injury to heart
    • Coronary Heart Disease-leading cause
    • Myocarditis
    • viral or bacterial infection
    • pulmonary embolism
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6
Q

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

A
  • Hypertension
  • Cardiomyopathy
  • Valvular heart disease
  • Congenital heart disease
  • Pulmonary hypertension
  • Endocrine thyroid disease
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7
Q

Chronic Heart Failure

A
  • clinical syndrome arising from different causes
  • Not all pts have low ejection fracture
  • Types:
    • Left sided
    • Right Sided
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8
Q

Left Sided Heart Failure

A
  • Types:
    • Systolic Heart Failure
    • Diastolic Heart Failure
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9
Q

Left Sided Heart Failure: Symptoms

A
  • 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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10
Q

Systolic HF

A
  • 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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11
Q

Ejection Fraction

A
  • 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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12
Q

Diastolic HF

A
  • 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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13
Q

Right Sided Heart Failure: symptoms

A
  • 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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14
Q

Chronic Heart Failure: Diagnosis

A
  • 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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15
Q

Chronic Heart Failure Lab findings: (NOT BNP)

A
  • Polycythemia, thrombocytopenia, leucopenia
  • Depleted Coagulation factors
  • Urnie analysis
    • proteinuria
    • increased specific gravity
  • Abnormal Liver Function
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16
Q

New York Heart Association (NYHA) Classification

A
  • 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
17
Q

Hearts Compensatory Mechanism to Heart Failure

A
  • 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
18
Q

Chronic Heart failure Progression

A
  • Failed compensatory mechanism causes inadequate CO
  • FINISH
19
Q

CHF Treatment

A
  • 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
20
Q

CHF Medications

A
  • Ace Inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Beta Blockers
  • Digoxin
  • Diuretics
21
Q

VADs

A
  • Ventricular Assist Device
  • improves pumping
  • LVAD
    • left ventricular assist device
    • pt w/bradycardia
22
Q

IABP

A
  • maintain heart function in left-side heart failure who are waiting for:
    • transplant
    • develop deterioration of heart function
23
Q

CHF Oral Manifestations

A
  • Infection
  • Bleeding
  • Petechiae
  • Ecchymoses
  • Drugs related oral dryness
  • Lichenoid mucosal lesions
24
Q

CHF: Potential problems related to dental care

A
  • 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
25
Q

Steps to take to prevent medical emergency in dental setting

A
  • 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
26
Q

How to prevent complications

A
  • 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
27
Q

Digoxin

A
  • Record base line pulse rate and rhyme
  • use Epinephrine & Anticholinergic w/caution
  • Avoid Tetracycline & Macrolide
    • result in increased serum conc. of digoxin
28
Q

Non-selective Beta Blockers

A
  • Epinephrine
    • can cause acute hypertensive effect
  • NSAIDs for 5+ days diminish effect
29
Q

Calcium Channel Blockers

A
  • Verapamil & Diltiazem
  • compete w/macrolide antibiotics for metabolizing enzymes
30
Q

Diuretics

A
  • use of NSAIDs for 5+ days diminish use
31
Q

ACE Inhibitors

A

use of NSAIDs for 5+ days diminish use

32
Q

ARBs

A

use of NSAIDs for 5+ days diminish use

Week 77 (11 decks)

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