Lecture 4 Part 2 EXAM 2 Flashcards
What is Heart failure?
Occurs when heart muscle is impaired and no longer pumps sufficient blood to body tissues and organs.
Can occcur form any kind of Cardiovascular disease
How many people in the United States are affect by Heart failure?
5 million
What are the causes of Heart failure and what illness is associated with it?
- Myocardial Infraction (MI) and hypertension are most common cause
- Associated w/ Thyroid disease, renal insufficiency and pulmonary disease
When does signs of HF occurs?
Intial- at exertion
Progression- at rest
What can HF lead to ?
pulmonary edema
What are the clinical manifestation of HF?
- Left Ventricular HF
- Right Ventricular HF
- Both left and Right Ventricular HF
What is Left ventricuular HF
- Inability of the left ventricle to pump blood to the body tissues
- occurs before right ventricular HF
- May back up causing leak into the lungs
- Occurs when PT is supine
What are signs and symptoms of left heart failure ?
- Classic sign dyspnea (shortness of breath)
- Tachypnea
- Dry cough
- Cardiac Asthma
- Pale and cool to touch
- Diaphoresis (sweating)
- Increased BP
- Pluse rapid and thready
What is the ASA level for a PT with Left HF?
ASA III or IV
What is right heart failure?
Inability of the heart to pump blood from the systemic circulation to the lungs
What is symptoms of right heart failure?
- Congestion in systemic venous system
- Fatigue and weakness
- Peripherial edema
- Pitting edema in lower legs and ankles
- Reduction in renal blood flow
- Distended jugular vein
- Edema in abdomen
what are the signs and symptoms of later stages of heart failure?
- Mental confusion, anxiety and restlessness- lack of O2
- Cardiac cachexia- wasting of tissues
- Cyanosis
What are the treatment of Heart Failure?
- lifestyle chanegs can lessen symptoms
- Drug therapy: ACE inhibitors, diurectics, vasodilators, beta blockers, calcium channel blockers
What is the sign of heart failure in a dental setting?
- Swelling in feet or ankles, Shortness of breath, weight gain- POSTPONE treatment
- Cyanosis, Jugualr veins (Characterisitics observation)
- Vitals prior to and during treatment
How to manage a PT with ASA II Classification?
- Mild dyspnea and fatigue during excertion- may need 3-5 liters of supllemental oxygen
- Chairs upright position
How to manage a PT with ASA III Classification
Require medical consultation
- orthopnea
- modification in patient poitioning
- supplemental oxygen
How to manage a PT with ASA IV Classification
Elective treatment should be postpone until symptoms controlled
What is acute pulmonary edema?
Sudden accumulation of excessive fluid in the lungs, because of left venticular heart failure
Most dramatic life threating symptom of left HF
What are precipitating events of acute pulmonary edema?
- Stress
- Infection
- Failure to take medications
- Meal high in sodium
- Inhibits lung expansion
- Decreased ability of lungs to oxygenate blood
What are the signs and symptoms of Acute pulmonary edema?
- Gasping for air
- Rapid Pulse
- Cool, moist skin
- Cyanotic lips and nail beds
- Anxiety
- Dyspnea with cough that may produce frothy blood
- Loud coarse lunge sounds
What are the treatment of acute pulmonary edema?
- Focus on reduction of fluid in lungs
- Sitting patient upright redirects blood to lower
- Drug therapy
- Oxygen
- Severe cases needs intubated and ventilated mechanically in hospital
What is the treatment for Acute Pulmonary Edema in a dental setting?
- Contact EMS
- Terminate all treatment
- Reduce patient anxiety to reduce cardiac and respiratory workload
- Position patient comfortably, upright
- Compressions, Airway, Breathing (CAB)
- O2 10 liters/minute or more
- Monitor Vital signs
- Nitroglycerine 2-3 tablets or spray 5-10 min
If Pt systolic BP below 100mmHg what should you not do?
Do not adminsiters nitroglycerine
