Congestive Heart Failure: Assessment, Analysis, and Associated Dental Management Guidelines
CONGESTIVE HEART FAILURE (CHF) SYMPTOMS AND SIGNS
The following are CHF symptoms:
1. Orthopnea: Orthopnea is shortness of breath experienced on lying down. Therefore, the patient should always be propped up in bed.
2. Paroxysmal nocturnal dyspnea or “cardiac asthma”: Shortness of breath is experienced hours or minutes after lying in bed.
3. Cough with frothy sputum: Severe CHF compromises cardiac output and this leads to pulmonary congestion or edema. Significant pulmonary congestion causes cough with a frothy sputum expectoration.
The following are CHF signs:
1. Distended neck veins: The forward flow of blood is compromised with CHF, causing a backup and consequent distention of the neck veins.
2. Rales on auscultation: Rales, or coarse crackles, on auscultation are heard in the base of both lungs and indicate the presence of fluid in the lungs.
3. Functional systolic murmur: CHF can be associated with a functional systolic murmur, and this murmur is corrected following treatment and recovery. This murmur is heard in the second left intercostal or pulmonic space upon physical examination of the chest.
4. Ankle edema: The compromised cardiac status causes fluid collection in the peripheral tissues and pitting edema. Pitting edema can be confirmed by applying transient pressure with your thumb on the patient’s edematous tissue, particularly on the feet, near the ankles. Transient pressure leaves a dent, indicating fluid collection.
CONGESTIVE HEART FAILURE MEDICAL MANAGEMENT
The type of CHF treatment implemented is dictated by the cause of CHF. In addition to the common drugs that have been used in the management of CHF, such as diuretics, vasodilators, ACE inhibitors, beta-blockers, and digoxin, there are newer drugs for heart failure (HF) management, per the 2012 guidelines. These are the highlighted changes in the guidelines for the Diagnosis and Treatment of />
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