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SU18: Internal med final > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

incidence

A

5.7 million Americans and increasing

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2
Q

how many people die from heart failure every year?

A
  • 56,000 deaths/year

- contributing cause in 262,000 deaths

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3
Q

pathophysiology

A

chronic, progressive inability of the heart to function as a pump

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4
Q

what happens if ventricles don’t empty during systole?

A

inadequate blood volume supplied to tissues

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5
Q

what happens if ventricles don’t fill during diastole?

A

backup of blood causing systemic congestion

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6
Q

common causes of heart failure

A
  • coronary heart disease
  • hypertension
  • cardiomyopathy
  • valvular heart disease
  • myocarditis
  • infective endocarditis
  • congenital heart disease
  • pulmonary hypertension
  • pulmonary embolism
  • endocrine disease
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7
Q

what percent of heart failure cases is caused by coronary heart disease?

A

60-75%

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8
Q

ejection fraction

A

reflection of heart’s efficiency as a pump

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9
Q

what guides the medical treatment of a pt with heart failure?

A

ejection fraction

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10
Q

what percent is considered a normal ejection fraction?

A

55-70%

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11
Q

what percent is considered a severe ejection fraction?

A

<35%

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12
Q

how is ejection fraction calculated?

A

amt of blood pumped out of ventricle/total amt of blood in ventricle

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13
Q

which ventricle normally will give out first?

A

left

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14
Q

symptoms of pts with heart failure with depend on what?

A

which side of the heart has failed

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15
Q

what are the cardinal symptoms of heart failure?

A
  • dyspnea

- fatigue

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16
Q

dyspnea is more of a failure on which side of the heart?

A

left

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17
Q

fatigue is more of a failure on which side of the heart?

A

right

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18
Q

pathophysiology of right ventricular failure

A
  • increased pressure and fluid retention
  • venous congestion
  • peripheral edema
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19
Q

pathophysiology of left ventricular failure

A
  • increased pressure and fluid retention
  • pulmonary hypertension
  • edema
  • increased perioheral resistance or myocardial disease
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20
Q

symptoms of heart failure

A
  • dyspnea
  • fatigue/weakness
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • pulmonary edema
  • dependent edema
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21
Q

orthopnea

A

dyspnea in recumbent position

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22
Q

paroxysmal nocturnal dyspnea

A

dyspnea awakening patient from sleep

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23
Q

pulmonary edema

A

cough

24
Q

dependent edema

A

swelling in legs/ankles

25
Q

pts with dependent edema is seen more in patients with which side of heart failure?

A

right

26
Q

prognosis of heart failure

A

poor (5-yr survival 35% men, 50% women)

- sudden death 6-9x that of general population

27
Q

1 year after diagnosis, what percent of ppl will die from heart failure?

A

20%

28
Q

stage A heart failure

A

at high risk for HF but without structural heart disease or symptoms of HF

29
Q

stage A heart failure pts

A

pts with

  • HTN
  • atherosclerotic disease
  • diabetes mellitus
  • obesity
  • metabolic syndrome

OR

  • using carcinotoxins
  • w/ family history of cardiomyopathy
30
Q

stage B heart failure

A

structural heart disease but without signs or symptoms of HF

31
Q

stage B heart failure pts

A

pts with

  • previous MI
  • left ventricular remodeling including left ventricular hypertrophy and low ejection fraction
  • asymptomatic valvular disease
32
Q

stage C heart failure

A

structural heart disease with prior or current symptoms of HF

33
Q

stage C heart failure pts

A

pts with

  • known structural heart disease
  • HF signs and symptoms
34
Q

stage D heart failure

A

refractory HF

*nothing is working for these pts so either need heart transplant or admit to hospice

35
Q

stage D heart failure pts

A

pts with

  • marked HF symptoms at rest
  • recurrent hospitalizations despite guideline-directed medical therapy
36
Q

how many classes are there in the classification of stage C heart failure?

A

4

37
Q

does class 1 have symptoms with activity?

A

no

38
Q

does class 1 have symptoms at rest?

A

no

39
Q

does class 2 have symptoms with activity?

A

yes but ordinary activity

40
Q

does class 2 have symptoms at rest?

A

no

41
Q

does class 3 have symptoms with activity?

A

yes but less than ordinary activity

42
Q

does class 3 have symptoms at rest?

A

no

43
Q

does class 4 have symptoms with activity?

A

yes

44
Q

does class 4 have symptoms at rest?

A

yes, pts are symptomatic no matter what they do

45
Q

which classes are pts considered decompensated?

A

2, 3, 4

46
Q

why is compliance difficult for pts with heart failure?

A

compliance difficult with life sentence to lifestyle mods and drug therapy

47
Q

can pts with HF receive elective dental care?

A 
depends on the status of HF
*can txt pts w/ class 2 &amp; 3 even though by the book, they're considered decompensated - just make sure there are no symptoms during activity or at rest
48
Q

a history of compensated heart failure is considered what type of risk factor?

A

intermediate

49
Q

perioperative risk is increased in pts unable to meet a MET demand of what?

A

≥4

50
Q

decompensated heart failure is considered what type of risk factor?

A

major

51
Q

what is the most common reason for pts to have episodes of decompensation?

A

noncompliance with meds

52
Q

what is the goal in your office for decompensated heart failure pts?

A

keep CV system status quo… no major shifts in heart rate or BP

53
Q

mods to dental txtment

A
  • antibiotics
  • manage anxiety/stress
  • bleeding (pts may be taking anticoagulants or antiplatelet agents)
  • chair position (pt may not tolerate supine position)
  • consultation to estabilish level of disease control (ejection fraction)
  • check drug interactions
  • profound local anesthesia, modest epi
54
Q

do pts with heart failure need antibiotic prophylaxis?

A
  • check with treating cardiologist

- left ventricular assist device may require

55
Q

can pts w heart failure take NSAIDS?

A

NO, will exacerbate syms

56
Q

can asymptomatic HF pts have dental txtment?

A

yes

57
Q

can symptomatic HF pts have dental txtment?

A

no, require further medical evaluation and optimizing prior to elective care

SU18: Internal med final (25 decks)

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