Implications in Dental Care I Flashcards
Definition of congestive heart failure \_\_\_\_ clinical syndrome Involves \_\_\_\_ disorders of the heart Impairs\_\_\_\_ of blood from the heart or \_\_\_\_ of the heart
complex
structural/functional
ejection
filling
congestive heart failure
____ progressive condition
Muscles of the heart are ____
Cannot pump adequate ____ blood to the body
Represents the ____ of many cardiovascular diseases
chronic
weak
oxygen-rich
end stage
Epidemiology of CHF
Singled out as an ____
____ patients 65 years and above have CHF
In 2013, approx. ____ million Americans with HF
Approximately ____ million people with HF worldwide
epidemic
4 in 5
5
23
Epidemiology of CHF
Prevalence increases with ____
Prevalence -25% higher in ____ compared with Caucasians
Projected to rise over next 40 years- with estimated 772,000 new cases
age
AA
Etiology – any disease that weakens the heart
\_\_\_\_ disease Hypertension Dilated \_\_\_\_ Coronary artery disease \_\_\_\_ Untreated valvular dx Myocarditis \_\_\_\_ Congenital heart disease \_\_\_\_ Diabetes
ischemic heart
cardiomyopathy
infective endocarditis
pulmonary embolism
Compensatory mechanism and its sequlae- in response to diseases affecting the heart
____- contractile cells of the heart muscles become more in number
____- the heart becomes larger because the heart muscle stretches
____- heart pumps faster to increase oxygen output
hyperplasia
hypertrophy
tachycardia
Compensatory mech. (contd)
Increased ____- from narrowing of blood vessels
Blood is diverted from less important body organs e.g. ____
Kidneys retain more ____ and electrolyte leading to increased ____ volume.
Congestion of fluids occur in tissues – already weakened heart has to do more ____
BP kidney water interstitial work
Left sided HF
Left sided heart failure with reduced ejection fraction (____ failure)- muscles of left ____ are weak and can’t produce enough force to pump oxygenated blood out to the tissues (reduced ____)
Left sided heart failure with preserved ejection fraction (____ failure)- left ventricles muscles do not ____ adequately to fill with blood
Oxygenated blood is backed up in the ____, pulmonary artery and ____
Leads to ____
systolic ventricle cardiac ouput diastolic relax left atrium lungs congestion
Right sided heart failure
Caused by progressive ____ failure.
Fluids are backed up in the lungs, ____.
Consequently right side of the heart (Right ____ and right ____ are affected)
Pulling of blood and interstitial fluids in ____ and organs
left sided pulmonary vein atrium ventricles body tissues
CHF- signs and symptoms
____ especially ankle and knees (pitting edema)
GI/liver- ascites
____- as a result of fluid collecting in the lungs (pulmonary ____)
Coughing from pulmonary edema
____
Orthopnea
edema
shortness of breath
hypertension
fatigue
Classification of HF- NYHA
Class I : No limitation of ____. No dyspnea, ____, or palpitations with ordinary physical activity
Class II : ____ limitation of physical activity. Patients experience ____, palpitations, and dyspnea with ordinary physical activity but are comfortable at ____.
physical activity
fatigue
slight
fatigue
rest
NYHA classification
Class III : ____ limitation of activity. Less than ordinary physical activity results in ____, but patients are comfortable at ____.
Class IV : Symptoms are present with the patient at ____, and any physical exertion ____ the symptoms.
marked symptoms rest rest exacerbates
Compensated and Decompensated heart failure
Compensated heart failure – patient is usually ____ because heart compensates to increase ____
Decompensated heat failure- patient has worsening symptoms (e.g. ____, edema, ____, SOB)
asymptomatic
cardiac output
dyspnea
ascites
Role of Dentists in managing CHF patients
A major risk in providing dental treatment for a patient with symptomatic HF is that the symptoms could abruptly worsen with resultant acute failure, a fatal arrhythmia, stroke, or MI.
Identification of patients with a history of HF, those with undiagnosed HF, or those prone to developing HF is the first step in ____ and in avoiding an untoward event.
risk assessment
Legal implication for dentists
Treating dentists remain ____ accountable for decisions to treat patients, whether or not they
obtain a consultations from patients physician
The ____ is just one of the sources for obtaining the necessary information dentists use to make decisions and render treatment.
legally
medical consult
Dental considerations in treating a patient with CHF
Patients with untreated or mismanaged CHF at risk for stroke/CVA, MI, TIA or cardiac arrest in a dental chair.
Its important to know the ____ leading to the CHF. e.g. uncontrolled HBP versus cardiac valve diseases.
cardiac conditions
Management of patients with CHF
Monitor ____ and vital signs at every visit
Short ____ or ____ appointments
BP
early morning
early afternoon
Local Anesthesia
Achieve and maintain excellent anesthesia in order to reduce ____ and prevent cardiac crisis.
Use of epinephrine (1 : 100,000) at a dose of no more than ____ carpules in local anesthetics generally causes no problems
Clinicians should provide good ____ control
stress
2
postoperative pain
Management of patients with CHF
The use of epinephrine or other pressor amines (either in ____ or as agents to control bleeding) must be ____.
Note if the patient has any need for antibiotic prophylaxis
Pts may require ____
gingival retraction cord
avoided
anxiolytics
Management of patients with CHF
No elective dental treatment for patients in the 1st ____ months after an MI
Ensure you have access to ____ for patients with risk of angina
No ____ for patients with angina- because they will not be able to report an angina episode
6
nitrates
sedation
Dysrhythmia
Abnormality in heart rate, rhythm (regularity) or site of origin of cardiac impulses
Problems with ____ and/or ____ of cardiac impulses- (results in altered ventricle and atrial sequence).
Some are life threatening
generation
conduction
Could be present in ____ patients occasionally – result of anxiety, fever, rapid blood loss or strenuous exercise
Typically present in patients with ____
healthy
cardiac diseases
Causes of dysrhythmia \_\_\_\_, fever, strenuous exercise Side effect of \_\_\_\_ (tea, coffee, or soda), chocolate, tobacco (\_\_\_\_) Primary heart diseases Pulmonary disease- \_\_\_\_ and pneumonia
stress
caffeine
paroxysmal supraventricular tachycardia
embolism
Causes of dysrhythmia Autonomic disorders e.g. \_\_\_\_ Systemic disorders- e.g. \_\_\_\_ (hyperthyroidism) Drug-related side effects \_\_\_\_ imbalance
autonomic neuropathy
thyroid problems
electrolyte
