Term
| Is heart failure(HF) an actual diagnosis? |
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Definition
| no, it mainly manifests at the end of other cardiovascular diseases |
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Term
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Definition
| the inability of the heart to adequately supply blood to fit the body's needs |
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Term
| What are patients with untreated or poorly managed HF at risk for during dental procedures? |
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Definition
| cardiac arrest(AF, heart stops beating randomly), stroke (cerebrovascular accident), and MI(blockage causing necrosis) |
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Term
| Is the prevalnce of HF increasing? Why? |
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Definition
| yes, because advances in technology allow us to live longer, and HF is more common in old people |
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Term
| Do patients with HF always know they have it? |
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Definition
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Term
| What are some things that can cause HF? |
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Definition
-Impaired myocardial contractility
-Increased ventricular stiffness or impaired myocardial relaxation
-A variety of other cardiac abnormalities
-States in which the heart is unable to compensate for increased peripheral blood flow or metabolic requirements |
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Term
| What is the most common underlying cause of HF? Second most common? What else causes it? |
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Definition
-coronary heart disease or coronary artery disease
-second most common cause is dilated cardiomyopathy
-hypertension also causes HF |
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Term
| Does HF affect one or both ventricles? |
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Definition
| either, left is usually first |
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Term
| What are the cardinal manifestations of HF? |
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Definition
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Term
| What is the common symptoms with HF of the left ventricle? |
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Definition
|
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Term
| What does pulmonary hypertension do? |
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Definition
| increases the work of the right ventricle pumping against increased pressure |
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Term
| What is failure of the right side of the heat caused by? |
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Definition
| failure of the left, rarely occurs alone |
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Term
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Definition
| enlargement of the right side of the heart caused by a lung disorder(emphysema) |
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Term
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Definition
| , stimulation of the renin-angiotensin system and the sympathetic nervous system compensate for loss of function, compensated HF is when this actually works and the symptoms go away |
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Term
| What is decompensated HF? |
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Definition
|
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Term
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Definition
| denote the status of patients with risk factors that predispose to the development of HF, but who do not have any symptoms of HF |
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Term
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Definition
| is for patients with past or present symptoms of HF associated with underlying structural heart disease |
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Term
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Definition
| is for patients with refractory HF who might be eligible for specialized, advanced treatment or for end-of-life care |
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Term
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Definition
| no, it is a progressive disease |
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Term
| What does left ventriular failure result in? |
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Definition
| pulmonary vascular congestion with resulting pulmonary edema and dyspnea |
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Term
| What is the most common symptom of HF? When is it usually present? |
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Definition
| Dyspnea, usually is present only with exertion or physical activity |
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Term
| What does dyspnea at rest indicate? |
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Definition
|
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Term
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Definition
| positional dyspnea precipitated or worsened by the patient assuming a recumbent or semirecumbent position |
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Term
| What is Paroxysmal nocturnal dyspnea (PND)? |
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Definition
| a sudden, severe shortness of breath awakening patient from sleep |
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Term
| What may also be impaired in patients with advanced HF? |
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Definition
| central regulation of respiration |
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Term
| What can central regulation of respiration result in? |
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Definition
| alternating cycles of rapid, deep breathing with periods of central apnea, a pattern called Cheyne-Stokes respiration |
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Term
| What is one of the hallmark symptoms of HF? |
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Definition
| exercise intolerance, due to dyspnea and reduced blood to muscles |
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Term
| What are some things that are evidence of systemic venous congestion? |
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Definition
-The presence of distended neck veins
-A large, tender liver
-Peripheral edema
-Ascites |
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Term
| What may patients with chronic HF see? |
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Definition
|
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Term
| What are some tests used to diagnose and monitor patients with HF? |
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Definition
-Plain radiography of the chest
-Electrocardiogram
-Echocardiography
-Radionuclide angiography or ventriculography
-Exercise stress test
-Ambulatory electrocardiogram (Holter) monitoring
-Cardiac catheterization |
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Term
| How are stages A and B managed? |
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Definition
| management begins with risk reduction and includes the identification and treatment of underlying medical problems |
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Term
| What is done for the management of stage C HF? |
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Definition
-salt restriction and drug therapy is added
-Drug therapy begins with diuretics to control fluid retention |
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Term
| What are some other drugs besides diruetics used to treat HF? |
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Definition
-angiotensin-converting enzyme (ACE) inhibitors
-β-adrenergic blockers
-angiotensin receptor blockers (ARBs) |
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Term
| What are the first line drugs used to treat HF? |
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Definition
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Term
| What is principally used to treat residual symptoms not controlled by other drugs? |
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Definition
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Term
| What are some drugs used to treat HF is ACE inhibitors do not work? |
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Definition
| ARBs and direct-acting vasodilators |
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Term
| What are some drugs that worsen the clinical status of HF? |
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Definition
| These include nonsteroidal anti-inflammatory drugs (NSAIDs), most antiarrhythmic agents, and calcium channel blockers |
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Term
| What is used to treat refractory HF(Stage D) if drugs do not work? |
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Definition
| mechanical and surgical intervention (intra-aortic balloon counterpulsation, placement of a left ventricular assist device, and heart transplantation) |
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Term
| WHat has recently been used to benefit HF patients in class II or III? |
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Definition
| use of an implantable cardioverter-defibrillator (ICD) |
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Term
| What may Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea (PND), fatigue, or exercise intolerance indicate? |
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Definition
| HF or another cardiovascular disease |
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Term
| Those who are symptomatic have... |
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Definition
decompensated HF (NYHA classes II, III and IV)
(no symptoms=compensated class I) |
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Term
| Who must a med con be obtained for? |
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Definition
| decompensated(symptomatic HF) |
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Term
| Which patients with HF don't need a med con generally? |
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Definition
| ones who can achieve a 4 MET(can climb stairs), is not symptomatic |
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Term
| What is the most common reason for a change from compensation to decompensation? |
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Definition
| patients failure to take medication properly |
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Term
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Definition
Class I, Class II(after med con), Some class III(after med con)
SO rest of class III and class IV must be seen in a special care facility with monitoring |
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Term
| What are some changes in treatment? |
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Definition
-no supine chair position
-no epinephrine for patients taking Digoxin
-stress reduction |
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Term
| If use of epinephrine is NECESSARY, how much can be used? |
|
Definition
A maximum of 0.036 mg of epinephrine (i.e., two cartridges of 2% lidocaine with 1:100,000 epinephrine)
-dont use gingival retraction cord with epinephrine impregnated in it |
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Term
| What if vascoconstritors must be used in someone who is a class III or IV? |
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Definition
| a med con must be obtained first |
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Term
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Definition
| may exaggerate the gag reflex |
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Term
| What is the most common cause of right-sided heart failure alone? |
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Definition
|
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Term
| How many patients die a year after being diagnosed with HF? |
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Definition
|
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Term
| How often does sudden death occur in people with HF? |
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Definition
| 6-9 times more likely than general population |
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