Heart Failure Flashcards
incidence
5.7 million Americans and increasing
how many people die from heart failure every year?
- 56,000 deaths/year
- contributing cause in 262,000 deaths
pathophysiology
chronic, progressive inability of the heart to function as a pump
what happens if ventricles don’t empty during systole?
inadequate blood volume supplied to tissues
what happens if ventricles don’t fill during diastole?
backup of blood causing systemic congestion
common causes of heart failure
- coronary heart disease
- hypertension
- cardiomyopathy
- valvular heart disease
- myocarditis
- infective endocarditis
- congenital heart disease
- pulmonary hypertension
- pulmonary embolism
- endocrine disease
what percent of heart failure cases is caused by coronary heart disease?
60-75%
ejection fraction
reflection of heart’s efficiency as a pump
what guides the medical treatment of a pt with heart failure?
ejection fraction
what percent is considered a normal ejection fraction?
55-70%
what percent is considered a severe ejection fraction?
<35%
how is ejection fraction calculated?
amt of blood pumped out of ventricle/total amt of blood in ventricle
which ventricle normally will give out first?
left
symptoms of pts with heart failure with depend on what?
which side of the heart has failed
what are the cardinal symptoms of heart failure?
- dyspnea
- fatigue
dyspnea is more of a failure on which side of the heart?
left
fatigue is more of a failure on which side of the heart?
right
pathophysiology of right ventricular failure
- increased pressure and fluid retention
- venous congestion
- peripheral edema
pathophysiology of left ventricular failure
- increased pressure and fluid retention
- pulmonary hypertension
- edema
- increased perioheral resistance or myocardial disease
symptoms of heart failure
- dyspnea
- fatigue/weakness
- orthopnea
- paroxysmal nocturnal dyspnea
- pulmonary edema
- dependent edema
orthopnea
dyspnea in recumbent position
paroxysmal nocturnal dyspnea
dyspnea awakening patient from sleep
pulmonary edema
cough
dependent edema
swelling in legs/ankles
pts with dependent edema is seen more in patients with which side of heart failure?
right
prognosis of heart failure
poor (5-yr survival 35% men, 50% women)
- sudden death 6-9x that of general population
1 year after diagnosis, what percent of ppl will die from heart failure?
20%
stage A heart failure
at high risk for HF but without structural heart disease or symptoms of HF
stage A heart failure pts
pts with
- HTN
- atherosclerotic disease
- diabetes mellitus
- obesity
- metabolic syndrome
OR
- using carcinotoxins
- w/ family history of cardiomyopathy
stage B heart failure
structural heart disease but without signs or symptoms of HF
stage B heart failure pts
pts with
- previous MI
- left ventricular remodeling including left ventricular hypertrophy and low ejection fraction
- asymptomatic valvular disease
stage C heart failure
structural heart disease with prior or current symptoms of HF
stage C heart failure pts
pts with
- known structural heart disease
- HF signs and symptoms
stage D heart failure
refractory HF
*nothing is working for these pts so either need heart transplant or admit to hospice
stage D heart failure pts
pts with
- marked HF symptoms at rest
- recurrent hospitalizations despite guideline-directed medical therapy
how many classes are there in the classification of stage C heart failure?
4
does class 1 have symptoms with activity?
no
does class 1 have symptoms at rest?
no
does class 2 have symptoms with activity?
yes but ordinary activity
does class 2 have symptoms at rest?
no
does class 3 have symptoms with activity?
yes but less than ordinary activity
does class 3 have symptoms at rest?
no
does class 4 have symptoms with activity?
yes
does class 4 have symptoms at rest?
yes, pts are symptomatic no matter what they do
which classes are pts considered decompensated?
2, 3, 4
why is compliance difficult for pts with heart failure?
compliance difficult with life sentence to lifestyle mods and drug therapy
can pts with HF receive elective dental care?
depends on the status of HF *can txt pts w/ class 2 & 3 even though by the book, they're considered decompensated - just make sure there are no symptoms during activity or at rest
a history of compensated heart failure is considered what type of risk factor?
intermediate
perioperative risk is increased in pts unable to meet a MET demand of what?
≥4
decompensated heart failure is considered what type of risk factor?
major
what is the most common reason for pts to have episodes of decompensation?
noncompliance with meds
what is the goal in your office for decompensated heart failure pts?
keep CV system status quo… no major shifts in heart rate or BP
mods to dental txtment
- 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
do pts with heart failure need antibiotic prophylaxis?
- check with treating cardiologist
- left ventricular assist device may require
can pts w heart failure take NSAIDS?
NO, will exacerbate syms
can asymptomatic HF pts have dental txtment?
yes
can symptomatic HF pts have dental txtment?
no, require further medical evaluation and optimizing prior to elective care
