congestive heart disease In dental practice.

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Congestive heart
failure

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

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• 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.
• Simply, 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 ?

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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 :

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• 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.

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● 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:

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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:

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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.

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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.

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

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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.

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Relation to Dental practice:
• First : (Assessment for Prevention of Problems):
1. 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).
2. 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.
3. 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.

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4 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 ):
1. 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.
2. Patients with shorter visits and in semi-supine or upright position during treatment to
decrease collection of fluid in lung
3. Monitor blood pressure and Appointment terminated if patient becomes fatigued or
stressed.
4. Regular Oral Hygiene visits (1 per 6 months)

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

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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/