This document discusses heart failure, including its definitions, types, causes, clinical manifestations, and management from a dental perspective. It defines heart failure as the heart's inability to supply sufficient oxygenated blood to the body's needs. The types include left ventricle, right ventricle, and combined failure. Causes include congenital heart defects and conditions like cardiomyopathy. Clinical manifestations vary depending on which ventricle is affected but may include edema, dyspnea, fatigue, and cyanosis. Dental management involves recognizing signs of failure, terminating procedures if needed, positioning the patient comfortably, and providing post-procedure care and follow-up.

2. Objectives
s Definitions:
s Types:
s Causes of H.F.
s ASA Physical Status Classification
s Clinical Manifestations of H.F.
s Management:

3. Definition:
s heart failure
means inability of the heart
to supply sufficient oxygenated blood for the
body needs.

4. Types:
Left ventricle failure:
Failure occurs solely in the left ventricle ---s/s are
related to congestion of lung.
Right ventricle failure:
Failure occurs solely in the right ventricle – s/s are
related to systemic congestion.
Combination of both left and right ventricles failure =
congestive heart failure
there are both pulmonary &systemic congestion.

5. l Left
ventricle
failure:
l Right
ventricle
failure:
congestive
heart
failure

6. Heart
Physiology

7. Causes of H.F.
Congenital heart disease
s coarcatation of aorta.
s pulmonary stenosis.
s Cardiomyopathy
s Bacterial endo carditis
s Rheumatic carditis.

8. Congenital
heart
disease
as
–
coarctation
of
aorta.
pulmonary
stenosis.
Cardiomyopathy
Bacterial
endo
carditis
Rheumatic
carditis.

9. ASA Physical Status Classification
for CHF.
s ASA-I: No dyspnea, no fatigue with normal
exertion.
s ASA-II: Mild dyspnea, or fatigue during
exertion.
s ASA-III:
activity.
Dyspnea or fatigue with normal
s ASA-IV: Dyspnea, orthopnea and undue
fatigue at all times.

11. s ASA-I:
No special modification in
dental ttt.
s ASA-II:
Can be managed normally
Can use stress reduction prot.
s ASA-III:
there is ^^^Risk in dental ttt.
so Before any dental management :
ask for medical consultation
apply stress reduction protocol.

12. s
ASA-IV:
s Dental treatment should be withheld for all elective
procedures until the cardiovascular disorder is
controlled.
s Dental emergencies as pain or infections should be
managed with medication
s If intervention is necessary the patient should be
hospitalized under a physician care before , during and
after dental treatment.

13. Clinical
Manifestations

14. Clinical Manifestations
of H.F.
s
Left ventricular failure:
s
s
Weakness and undue fatigue.
Dyspnea:……..degrees of dyspnea
s
Dyspnea on exertion accompanied by:
s
s
s
s
s
Tachypnea.
Cough and expectoration.
Increased urination at night (nocturia).
Orthopnea.
Paroxysmal nocturnal dyspnea (exaggerated form
of orthopnea).

15. s NB,
s The patient awakens from sleep acutely, having
shortening of breath and gasping for air with
respiratory difficulty.
s There may be inspiratory and expiratory wheeze
……>> cardiac asthma.

16. s
s
Pale, sweaty, cool …skin.
Vital Signs: blood pre……pulse pre…..
s
Usually increased blood pressure more in diastolic
pr.
s
Pulse pressure narrow.
s
H.R. increased.
s
Pulses alternans (alternating strong and weak heart
beats).
s
Tachypnea, hyperventilation.

18. Right Ventricular H.F:
s/s of systemic venous congestion:
s Peripheral edema:
s Swelling of feet and ankles: more in day and in
night. Dependent or pitting edema in bedridden -in sacral region.
s Weakness and fatigue.
s Cyanosis: especially in mucous membrane.

19. Right
side
heart
failure
Peripheral
edema:
Swelling
of
feet
and
ankles:
Cyanosis:
Prominent
jugular
veins
Hepatomegaly:
splenomegaly.
abdominal
edema
…..
ascites.
GIT
congestion
…….anorexia,
nausea,
……
vomiting.
CNS.
Edema
-­‐
headache,
insomnia,
irritability.

21. s
Prominent jugular veins in nect.
s
Hepatomegaly: splenomegaly.
s
With progress of edema – abdominal edema
known as ascites.
s
GIT congestion - anorexia, nausea, vomiting.
s
CNS. Edema - headache, insomnia,
irritability.

22. s 3)
Combined left and right vent. V.
s All previous s/s are present.
s In addition:
s Hyperventilation – respiratory alkalosis:
s Cold hands.
s Tingling fingers..
s Anxiety.

23. Management
s R.
Recognize H.F.:
Left ventricular f.
Right ventricular f.
Congestive H.F.
s T.
Terminate dental procedure:
- Remove dental materials.

24. s P.
s
Position Care:
Should be in comfortable
in most cases – upright position is good
s
this allows sitting of fluid down in base of lung and
good ventilation for the rest of lung tissue.
s N.B. If patient looses consc. >>>> place him in supine
position.

25. s ABCD (basic life support) as needed
s M:
Call for medical emergency.
s
…..
send to hospital…
for other medial treatment as
phlebotomy, O2, drugs, as digitalis,
s
Calm the patient.
diuretics.

26. s Definitive Care:
s
Give O2.
s
Monitor vital signs.
s
Alleviate symptoms.
s Eg:
*****
^ blood pres………. By :
- phlebotomy (by tourniquets).
- Vasodilators: as

27. - Nitroglycerin:
s
Dose : 8 – 1.2 mg/every 5 mint.
s NB: Blood pressure should be above 100 mg to
give nitroglycerin.

28. s
*****of apprehension[…fear..] e.g. by opioid
like drugs as meperidine I.M. 25 mg.
s Subsequent dental ttt…
s Episodes of H.F. should be considered.

29. Dental
considerations
s Patient
position
(partially
recline
or
erect
position).
s Dental
treatment
may
precipitate
dysrhythmias,
angina,
or
heart
failure.
s For
patient
with
mild
controlled
cardiac
failure,
routine
dental
care
can
usually
be
provided
with
little
modification.
Anxiety
must
be
minimized
and
pain
control
must
be
fully
effective.
s For
patient
with
poorly
controlled
or
uncontrolled
cardiac
failure,
medical
attention
should
be
obtained
before
any
dental
treatment.

30. Dental
considerations
s Elective
dental
treatment
should
be
delayed
until
the
condition
has
been
stabilized
medically.
s Emergency
dental
care
should
be
conservative,
principally
with
analgesics,
and
antibiotics.
s Appointments
should
be
short.
s Patients
are
best
treated
in
the
late
morning.
s An
aspirating
syringe
should
be
used
to
give
LA.
Epinephrine
may
increase
hypertension
and
precipitate
dysrhythmias.

31. Dental
considerations
s Effective
analgesia
must
be
provided.
s Patient
on
medication
such
as
diuretics
may
cause
orthostatic
hypotension,
and
therefore
patients
should
be
raised
slowly
to
upright
position.