Dental Surgery assignment

Student : daniella dukmak

Student number : 21610236

CONGESTIVE HEART FAILURE(CHF) :

(hypertrophic cardiomyopathy)
It’s a chronic progressive condition that occurs as a result

of impaired pumping capability of the heart or when

excessive demands are placed on a normal myocardium ,

here the fluids build up around the heart and cause it to

pump inefficiently , so it happens when the ventricles of

the heart can’t pump enough blood volume to the body

demand and this will lead the blood and other fluids to
 get back up inside the lungs, abdomen , liver and lower

body causing pulmonary edema , hepatic dysfunction and

compromised intestinal nutrient absorption .

Signs and symptoms:

The lowered cardiac output causes :

1. Generalized weakness (fatigue)

2. Orthopnea (shortness of breath ) that indicates

pulmonary edema ( life threatening condition that

means that the lungs are filled with fluid because

the left side of heart can’t pump the blood

returning from the lungs) specially when the

patients in supine position (for example : sleeping or

laying down on the dental chair ) because this

position will increase the hydrostatic pressure in

lungs so most of these patients sleep with their

upper body supported on several pillows

3. Paroxysmal nocturnal dyspnea : is similar to

orthopnea but this awakes the patient from sleep

 having difficulty to breath and are forced to sit up

and try to catch their breath

4. Lower extremity edema ( ankles/feet/legs) : as we

said the heart is too weak to pump blood around

the body properly , because of that the blood

gathers in front of the heart …due to the increased

blood pressure in the veins , fluids come out into the

surrounding tissue (increasing the interstitial fluid)

….abdominal edema(ascites) could happen too

5. Weight gain

6. Dyspnea on exertion

7. Irregular rapid heart beat

8. Cough

9. Blue skin due to lack of oxygen in the sever heart

conditions

10. Chest pain

Causes of CHF??
All of these can lead to CHF:
  Hypertension

 Coronary artery disease

 Diabetes

 Thyroid disease

 Obesity

 Myocarditis

 Congenital heart defects

Diagnosis of CHF!
we can diagnose it by an electrocardiogram , MRI, blood

test ( by checking some hormones that rises with heart

failure like BNP), etc….

management of CHF and dental

management 
 patients with CHF should

follow low sodium diets to

reduce fluid retention

 they take also diuretics to

reduce the body’s content

 (thiazide diuretics

:metolazone ) (loop diuretics:

furosemide :lasix)

 they use also cardiac

glycosides like digoxin to

improve cardiac efficiency

 Afterload reducing drugs to

control the amount of work

the heart is required to do

( nitrates : relieve heart pain )

, ( beta blockers like acebutolol

: reduce blood pressure leading

the heart to beat more slowly

with less force) , (calcium

channel blockers : calcium

causes the heart ,arterioles to

contract more strongly so

blocking them allows blood

vessels to relax and open

 ACE inhibitors : these drugs

open up narrowed blood

vessels to improve blood flow :

captopril( capten)

 Patients with atrial fibrillation

: abnormal heart rhythm ..

these patients are prescribed

anticoagulants to prevent

thrombus formation

Dental
management 
:
How to deal with a CHF

patient in our dental clinic?

 First you have to make

sure that the heart

function has medically

 improved so you should

keep in touch with the

patient’s physician and

know exactly what are

the patients

medications so you can

only treat those who

are in stable condition

 Use an anxiety –

reduction protocol

 Program a visit in the

morning hours

 Avoid using the supine

position that might

cause orthopnea

 In patients with digoxin

drugs , the

vasoconstriction dose is

to be limited to two

anesthetic carpules ,
 since this drug

combination can favor

the appearance of

arrhythmias, also avoid

prescribing aspirin

because it leads to

sodium and fluid

retention

 In an emergency state

(lung edema) , seat the

patient with the legs

lowered and administer

nasal oxygen at rate of

4-6 liters/minutes ,

also nitroglycerin

sublingual tablets could

be used (0.4-0.8 mg)

to relieve chest pain

CHF complications and oral
manifestations:
1. Kidney damage/failure

2. Heart valve problem

3. Liver damage

4. Heart rhythm problem

Oral manifestations : ACEI’s drugs can produce

lichenoid reactions , burning mouth sensation

and loss of taste sensation while diuretics as

lasix can produce xerostomia

CHF prevention:
 Avoid smoking

 Maintain a well balanced healthy diet

 Stay active and exercise

 Reduce and manage stress

 Control your blood pressure and diabetes if

you have them

Conclusion:
 Cardiovascular diseases are the main causes of

death in the developed world , its important to

study them due to many patients subjected to

our clinics tending for dental treatment , an

inadequately controlled cardiological patient

constitutes a risk case in dental practice ; dental

surgeon therefore must take a series of aspects

mentioned before into account before treating

such patients in order to avoid complications

Referances :
http://www.medicinaoral.com/odo/volumenes/v3i2/j
cedv3i2p97.pdf
https://www.mayoclinic.org/diseases-
conditions/heart-failure/symptoms-causes/syc-
20373142

Contemporary Oral and Maxillofacial

Surgery book, 6e (page :10 -11)