Congestive Heart Failure

Question 1

Congestive Heart Failure

• inability of heart to supply enough blood circulation to meet the body’s needs
• 80% of patients diagnosed are over 65 yrs old
• untreated/poorly controlled CHF: high risk for complications during dental procedures (MI, stroke)

Answer 1

Causes

Coronary heart disease, cardiomyopathy, HTN, IE, Pulmonary hypertension, PE

Pathophysiology

Inability of heart to pump effectively

Decrease cardiac output, systemic conogestion

Question 2

Left vs Right Sided Heart Failure

LVHF (most common)

• caused by HTN (increased workload) or cardiomyopathy
• eventually leads to RVHF

RVHF

• most commonly caused by LVHF
• pure RVHF = cor pulmonale = due to emphysema
• problem with venous return, results in systemic venous congestion, peripheral edema

Answer 2

Signs/Symptoms

• # 1 dyspnea (congestion of pulmonary vessels)
• Fatigue
• Peripheral edema
• Clubbing of the fingers
• Distended veins (esp neck)
• Ascites (distended stomach)
• Large, tender liver (liver congestion)
• Enlarged heart on chest radiograph

Question 3

Medical Management

Diuretics (thiazides, loop/furosamide)

ACEI (prils)

Angiotensin receptor blocker (sartans)

Aldosterone inhibitor (spironolactone)

Beta blockers

Vasodilators (hydralazine)

Answer 3

Dental Management

Dental tx: No modification if CHF well controlled

Abx prophy: NO

BP: emergency if BP below 100/60

NSAIDS: Avoid! Can cause fluid retention (prostaglandin renal-protective: increase GFR)

EPI: 2 carp

Bleeding: anticipate due to coumadin, plavix

Chair: may be unable to fully recline