Ch. 11 Heart Failure and Acute Pulmonary Edema

Heart failure patients that are classified as ASA ____ can be managed normally in the dental setting provided that the rest of the medical history provides no contraindications to treatment.

ASA II

Patients wo experience dyspnea or fatigue under normal situations fall into the ASA ___ category.

ASA III

Cheyne-stokes can lead to an ASA _____ classification.

ASA IV

What is the most dramatic and life-threatening symptom of left heart failure?

Acute pulmonary edema

What is the result of a swift and abrupt accumulation of fluid in the alveolar spaces of the lungs?

Acute pulmonary edema

What are some cardiovascular conditions that lead to heart failure?

Congestive heart failure, MI, arrhythmias, mitral valve prolapse, hypertension, diabetes, thyroid disease, renal disease, and pulmonary disease

Pulmonary edema inhibits lung expansion and results in a ________ ability of the lungs to oxygenate the blood.

Decrease

Do patients with RV heart failure experience an increase or decrease in urine production during the day?

Decrease; there is an increase in urine production at night (nocturia) because the patient is less active and off the feet

Patients with LV heart failure usually have an elevated blood pressure with the ______ pressure being higher.

Diastolic

What's the first line of medications used to help patients with HF?

Diuretics

What is a cardinal symptom of heart failure?

Dyspnea

True or False: Lifestyle changes alone are not enough to lessen the symptoms of heart failure and prevent the disease from progressing.

False

True or False: The use of calcium channel blockers administered sublingually can be used instead of nitroglycerin to manage the symptoms of acute pulmonary edema.

False; they are not used unless they are being used to treat hypertension and/or angina associated with the patient's heart failure

What are the clinical symptoms for acute pulmonary edema?

Gasping for air, rapid pulse, cool and moist skin, cyanotic lips and nail beds, and anxiety

What is a clinical syndrome that occurs when the heart muscle becomes impaired and no longer effectively pumps sufficient volumes of oxygenated blood to the body's tissues and organs?

Heart failure (HF)

What is pulsus alternans?

Heartbeats alternate between strong and weak

Beta blockers and calcium channel blockers are often used when the dysfunction is secondary to ______ or _______.

Ischemic heart disease or hypertension

What are five signs and symptoms of the later stages of heart failure?

Mental confusion, anxiety, restlessness, cardia cachexia (malnutrition and wasting away of the tissues), and cyanosis

Which part of the heart collects poorly oxygenated blood from the body?

Right atrium

The result of RV heart failure is congestion of blood in the _________ system.

Systemic venous

ACE inhibitors, digoxin, diuretics, vasodilators, and beta blockers are used for the treatment of _______ failure.

Systolic failure

What occurs when the left ventricle loses its ability to contract normally?

Systolic failure

Know all of the signs and symptoms of right and left heart failure

Table 11.1 on page 130 in the old textbook

Are both statements true or false: Left ventricle heart failure usually occurs after right ventricular heart failure and is often the result of an acute myocardial infarction and/or cardiomyopathy.

The first statement is false (it occurs before) and the second is true

What occurs in systolic failure?

The force of the ventricular contraction is inadequate and not enough oxygenated blood is pumped into circulation

What occurs in diastolic failure?

The left ventricle cannot fill completely with oxygenated blood during the period between heartbeats

True or False: Cheyne-stokes is a type of orthopnea.

True

True or False: EMS should be called immediately if a patient is experiencing pulmonary edema.

True

True or False: If physical or psychological stress is anticipated during the provision of dental care, the clinician may consider the use of supplemental oxygen at a flow rate of 3 to 5 L per minute.

True

True or False: Right ventricular heart failure usually develops after left ventricular failure has been present for a varying amount of time.

True

What treatment should be provided if a patient is experiencing suffocation?

A nasal cannula can be substituted for a non-rebreather mask at a rate of 5 L/minute

Clinical symptoms for LV heart failure become more prominent at night (when patient is in supine position) and are primarily related to ________.

Respiratory distress

What may accompany dyspnea in a patient who is experiencing acute pulmonary edema?

A cough that produces frothy, blood-tinged sputum

Are both statements true or false: People diagnosed with heart failure usually die from conditions associated with the disease, and can live for 15-20 years with it.

Both statements are true

Are both statements true or false: The administration of nitroglycerin is indicated in the management of acute pulmonary edema and heart failure. The administration of nitroglycerin is contraindicated in patients with a systolic pressure lower than 100 mmHg.

Both statements are true

How can heart failure initially be classified?

By which side of the heart it effects, either left or right; over time it usually effects both sides of the heart

What is characterized by a period of deep breathing when atrial carbon dioxide pressure is high and shallow or no breathing when atrial carbon dioxide pressure is low?

Cheyne-Stokes respirations

What kind of respirations will precipitate nocturnal dyspnea and/or contribute to daytime sleepiness?

Cheyne-Stokes respirations

Which class of heart failure has no limitation of physical activity, absence of dyspnea, fatigue, or heart irregularities or palpitation with normal physical activity? They also have a diagnosis.

Class A

Which class of patients would we provide elective treatment for?

Class A and B

Which class of heart failure has mild symptoms of fatigue, palpitation, or dyspnea with normal physical activity, and are comfortable at rest?

Class B

Which class of heart failure has marked limitation of activity and normal physical activity produces increased symptoms of HF but patient is comfortable at rest?

Class C

Which class of patients requires a medical consultation before treatment?

Class C

What class of heart failure has mild symptoms present even when patient is at rest?

Class D

Which class of patients would not be provided elective treatment unless CHF is better controlled?

Class D

Is it an increase or decrease in fluid pressure that ultimately damages the right side of the heart?

Increase

Which part of the heart collects oxygenated rich blood from the lungs?

Left atrium

Which part of the heart sends oxygenated blood out to the rest of the body?

Left ventricle

What kind of heart failure results in a fall of cardiac output?

Left ventricle heart failure

What kind of heart failure causes blood to "back up" in the lungs and cause fluid to leak into the lungs, or pulmonary edema?

Left ventricular heart failure

The use of ________ containing epinephrine should be considered carefully when treating patients with heart failure.

Local anesthetics

What is the clinician's primary concern when treating a patient with pulmonary edema?

Maintaining an airway and breathing

Watch out for _______ when diuretics are being used on a patient.

Orthostatic hypotension

What are some situations in which the clinician should avoid treatment on a patient with HF?

Patients who experience orthopnea, extreme fatigue, nocturnal dyspnea, and excessive unexplained weight gain

What is the major clinical symptom of RV heart failure?

Peripheral edema

What is characterized by a depression that remains in the tissue for a few seconds after release of digital pressure to the area?

Pitting edema

Which part of the heart sends poorly oxygenated blood to the lungs where it picks up oxygen and gets rid of carbon dioxide?

Right ventricle

The presence of a distended external jugular vein while lying or sitting is a clinical manifestation of which heart failure?

Right ventricular heart failure

What is a result of the inability of the heart to pump oxygen-poor blood from the systemic venous circulation into the lungs for oxygenation?

Right ventricular heart failure

Which stages of heart failure are used to classify those patients without signs or symptoms of heart failure but who are at risk because of risk factors or heart abnormalities?

Stage A and B

Which stage of heart failure is used to represent those patients with current or past symptoms of heart failure, such as shortness of breath?

Stage C

Which stage of heart failure is used to classify patients with refractory heart failure, and may qualify for advanced treatment (heart transplant)?

Stage D