congestive heart disease.pptx

congestive heart disease In dental practice.

1. Congestive heart failure

2. What is Congestive heart failure ? Outline: Diagnosis Clinical Manifestations (How to identify ? ) Treatment 01 02 03 04 Relation to Dental Practice 05

3. • The term congestive heart failure (CHF) is used interchangeably with the term heart failure ; they both indicate the same condition. It is a condition that results from the inability of the heart to pump blood effectively to the rest of the body or the heart requires a higher filling pressure in order to pump effectively . • S imply , Congestive heart failure means that your heart can’t pump enough blood to keep all your body’s tissues and organs working properly. What is Congestive heart failure ?

4. Difference between Heart attack and Heart failure : • Heart attack is Sudden death of a section of the heart muscle caused by a decrease in blood supply to that area. • Heart failure An illness in which the heart doesn’t pump blood through the body as it should. Heart failure has no cure, but it can be treated with medications, diet, and other lifestyle changes NOTE :

5. • Sometimes CHF develops quickly, over days to weeks, but most often congestive heart failure develops slowly, as the heart gradually weakens and has more difficulty keeping up with its workload. • Heart failure may range in severity from a moderate decrease in function without any symptoms to significant damage that leaves a person seriously weakened and very symptomatic . • Heart failure is usually a chronic disease. That means it’s a long-term condition that tends to become worse gradually.

6. American College of Cardiology/American Heart Association classification: Stage A.  There are several risk factors for heart failure but no signs or symptoms. Stage B.  There is heart disease but no signs or symptoms of heart failure. Stage C.  There is heart disease and signs or symptoms of heart failure. Stage D.  Advanced heart failure requires specialized treatments. Classification Congestive heart failure:

7. The most common cause of congestive heart failure is  coronary artery disease . Risk factors for coronary artery disease include : high levels of  cholesterol  and/or triglyceride in the blood high blood pressure poor diet a sedentary lifestyle diabetes smoking being overweight or obese stress In addition to coronary artery disease, several other conditions can damage the heart muscles, including infections, autoimmune diseases, and some treatments such as  chemotherapy . Risk Factors of Congestive heart failure:

8. Dignosis : Careful medical history, review the symptoms and perform a physical examination. The doctor will also check to see the risk factors for heart failure, such as high blood pressure, coronary artery disease or diabetes. The doctor can listen to lungs for signs of fluid buildup (lung congestion) and heart for whooshing sounds (murmurs) that may suggest heart failure. The doctor may examine the veins in neck and check for fluid buildup in abdomen and legs. After the physical exam, the doctor may also order some of these tests : Blood tests. Chest X-ray. Electrocardiogram (ECG). Echocardiogram. Stress test.   Cardiac computerized tomography (CT) scan.   Magnetic resonance imaging (MRI). Coronary angiogram. Myocardial biopsy.  

9. Clinical Manifestations : Dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea Reduced exercise tolerance, lethargy, fatigue Nocturnal cough Wheeze Ankle swelling Anorexia Most commonly, a patient may experience shortness of breath, fatigue, problems with the heart’s rhythm called  arrhythmias , and edema—or fluid buildup—in the legs. Symptoms may be mild or severe and may not always be noticeable.

10. Oral Manifestations : Infection Bleeding Petechiae Ecchymoses Drug related Xerostomia or Lichenoid mucosal lesions

11. Treatment : Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger. Doctors sometimes can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, treatment of heart failure involves a balance of the right medications and, sometimes, use of devices that help the heart beat and contract properly . Surgery or other procedures to implant cardiac devices may be recommended to treat the underlying problem that led to heart failure.

12. R e lation to Dental practice: • First : ( Assessment for Prevention of Problems) : Detection of classification of patient for heart failure for quick assessment and possible referral to physician and no routine dental care until patient under good medical management (class I or II but caution for class III and contraindicated for class IV until stabilized). Patients need to be under good medical management and the cause of heart failure and any other complications must be controlled prior routine dental care including : Hypertension – Renal failure. Assessment of oral manifestations of disease. • Patients with CHF need special attention during dental care including avoiding procedures that can strain the heart, use of adequate pain control, monitoring blood pressure, shortened visits, and a cautious eye to possible complications. They also need special attention regarding preventing oral infections and periodontal disease that may contribute to further cardiac problems.

13. Assess for adverse events from medication use: a. Digitalis—patient more prone to nausea and vomiting . b . Anticoagulants—dosage should be reduced so that prothrombin time is 2.5 times. • Second : ( Treatment Planning ) : For class I or II patients, maximum 0.036 mg epinephrine or 0.20 mg levonordefrin to be used; vasoconstrictors avoided in class III or IV patients. Patients with shorter visits and in semi-supine or upright position during treatment to decrease collection of fluid in lung Monitor blood pressure and Appointment terminated if patient becomes fatigued or stressed. Regular Oral Hygiene visits (1 per 6 months)

14. • Third : ( Instructions to patient) : May required send to physician or cardiologist to allow dental procedure Alert the dentist of the medical history Maintain good oral hygiene Monitor their symptoms that may suggest complications

15. References: • 100 Questions & Answers About Congestive Heart Campion Quinn • Dental Recommendations for Preventing Complications in Patients with Chronic Conditions Health Partners Research Foundation eDent Study • https ://www.yalemedicine.org/