Heart Failure

Question 1

What is heart failure?

Answer 1

It’s the pathophysiological process in which the heart is unable to pump adequate amounts of blood to meet the metabolic requirements of the tissue for oxygen and substrates despite the venous return to the heart is either normal or increased . Caused by many things including, IHD,RHD, hypertensive heart failure or cardiomyopathy etc etc.

Question 2

Pathophysiology of heart failure?

Answer 2

• cardiac remodelling and inflammation , heart has compensatory response , due to the higher load than normal hayehsalo hypertrophy (compensatory stage) then it starts getting weaker and unable to compensate anymore so that will lead to heart failure.
  If there is heart failure in one chamber there will be blood stagnation in the previous chamber

Question 3

Left sided heart failure?

Answer 3

• hypertension will cause lots of pressure in the aorta causing left ventricular hypertrophy and then left sided heart failure, stagnation will occur before that which is the pulmonary veins and lungs leading to pulmonary congestion. Dam fel lungs
  Can be impaired gas exchange leading to cyanosis and signs of hypoxia

Question 4

Symptoms and clinical picture of left sided heart failure?

Answer 4

• dyspnea
• progressive dyspnea gets worse as the blood in the lung increases khales lead pulmonary edema
• paroxysmal nocturnal dyspnea (never a full sleep kol shewaya yesha 3ala karshet nafas ,) due to increased venous return so increased pulmonary congestion
• orthopnea (can’t lie supine has to stay upright even while sleeping)
• cough with frothy sputum

Question 5

Right sided heart failure + clinical picture

Answer 5

If there is right sided heart failure then there will be stagnation in the inferior and superior vena cava , leading to systemic congestion (no dyspnea khales because no congestion in lungs)
- congested neck veins / jugular venous distention since the superior vena cava can’t fade fel right atriu,
- inferior, ba2i el venous return
1. Ascites from git
2. Lower limb edema
3. Impaired liver function

Question 6

How to investigate heart failure?

Answer 6

• chest x ray shows cardiomegaly (cardiothoracic ratio)
• echocardiography , shows contractility to see what extent of heart failure is

Question 7

Treatment for heart failure?

Answer 7

1. Control risk factors
2. Treat symptoms via:
   -a- loop diuretics: depletes body of salt and water
   -b- salt restriction
   -c- digoxin: especially with atrial fibrillation, inotropic meaning it modifies force and speed of contraction , strengthens cardiac muscle and controls heart rate
3. Disease treatment: long term ACEi or ARBs because it will decrease cardiac remodelling and inflammation
   Beta blockers with caution (monitor bp and pulse) , lowers load on the heart
4. Cardiac transplant

Question 8

What is a cardiomyopathy?

Answer 8

Disease of the heart muscle where the walls become thick and stiff and unable to properly pump blood around the body

Question 9

Relevance of cardiomyopathies to dental practice?

Answer 9

• structural abnormalities = predisposition to infective endocarditis , so also control oral hygiene
• impaired heart function = limitations with anaesthesia , may need inpatient dental care if GA required
• arrhythmias may be potentiated with adrenaline in local anaesthesia
  If it occurs, assess ABC and start CPR if theres cardiac or respiratory arrest
  Administer oxygen
  Arrange emergency transport to hospital