Heart Failure

Question 1

What is the incidence of heart failure in the US? In a typical dental practice?

Answer 1

5.7 million patients

14 patients

Question 2

What is a chronic, progressive condition in which the heart is failing as a pump?

Answer 2

heart failure

Question 3

What is the mortality rate within 1 year of diagnosis of heart failure?

Answer 3

20%

Question 4

Explain the different classes of heart failure.

Answer 4

Class I: No symptoms with activity.
Class II: Symptoms with activity, none at rest.
Class III: Marked limitation. Symptoms with minimal activity, none at rest.
Class IV: Symptoms at rest and worse with activity.

Question 5

Which classes of heart failure are compensated? Decompensated?

Answer 5

compensated - class I
decompensted - classes II - IV

Question 6

What are the medical managements for an ASYMPTOMATIC patient?

Answer 6

1. risk reduction - smoking cessation
2. treatment of other underlying medical problems
3. exercise
4. health, low sodium diet

Question 7

What are the medical managemnts for SYMPTOMATIC pateints?

Answer 7

1. drugs
   - rid excess body fluid (diuretics)
   - slow the heart rate (beta blockers)
   - dilate vessels (ACE inhibitors)
   - +/- digoxin (cardiac glycoside)
2. Left ventricular assist device
3. heart transplant

Question 8

What is the goal for dental offices with heart failure patients?

Answer 8

keep the CV system status quo! No big shifts in heart rate or blood pressure

providing care may result in:

• worsening symptoms
• acute failure
• arrhythmia
• myocardial infarction
• cardiac arrest
• stroke

Question 9

When SYMPTOMATIC either going to have fluid backed up into the ___ or the ___.

Answer 9

lungs; body

Lungs (SOB; Orthopnea; Coughing, wheezing with exertion)
Body (Swelling in feet, ankles, legs; Weight gain from fluid overload; Muscle fatigue)

Question 10

What classification includes asymptomatic/mild heart failure? symptomatic?

Answer 10

NYHA I, II

NYHA III, IV

Question 11

Is elective treatment ok for patients with NHYA I, or II? What is the plan?

Answer 11

Elective treatment ok, provided they have good functional reserve

Plan
Reduce stress/anxiety
May not tolerate supine chair position
Avoid epinephrine with digoxin
Avoid NSAIDs??  Is a couple of days ok?

Question 12

Is elective treatment ok for patients with NHYA III, or IV? What is the plan?

Answer 12

Elective care deferred

Emergency care limited to noninvasive measures (In consultation with physician)

Question 13

T/F. Heart failure patients under good medical management require further medical evaluation and optimizing prior to elective care.

Answer 13

False, Heart failure patients under good medical management can have dental treatment.

Patients with symptomatic HF require further medical evaluation and optimizing prior to elective care.