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• W136531871 abstract "Chronic CHF may transform into acute CHF after seemingly innocent stresses, and activities that might not precipitate acute CHF in cool weather may precipitate an emergency in hot or humid weather. The precipitating stressor may have occurred 2 days before the acute problem. It is therefore possible for a patient with previously well-controlled CHF to present with a normal history and actually have a life-threatening problem. Pulmonary edema or a fatal dysrhythmia may develop rapidly, and these possibilities must be kept in mind. Both CHF and cardiac dysrhythmias may develop between appointments scheduled relatively close together. The mechanism for this may involve silent, or subclinical, myocardial infarctions. In one case, a patient was brought to the oral diagnosis service by a dental resident. The resident indicated that the patient presented for extensive dental treatment, and the pulse showed eight skipped beats per minute. The patient had a given a history of good health but had experienced “severe flu” a few months before. The “flu” symptoms included nausea and vomiting as well as severe fatigue and weakness. The patient had not been able to leave his bed for almost a month. Along with general aches and pains, the patient related aching in his left arm when specifically questioned. The patient was immediately referred to the medical center and was diagnosed as having a severe recent myocardial infarction. Aside from other problems, this patient was at increased risk for both CHF and cardiac dysrhythmias. CHF and disorders of the heart beat are only two of many conditions that affect the heart and cardiovascular system. The management of patients who are known to suffer from either of these conditions is made easier if the diagnoses of the disorders have already been made. Each patient’s condition should still be monitored. Vital signs taken at each appointment should be compared against baseline values. The patient should be asked about any change in symptoms. In patients who have not been diagnosed as previously having cardiac disease, it is wise to keep in mind that cardiovascular disease is the most common cause of morbidity and mortality in the United States. The prudent clinician keeps the possibility of an undiagnosed cardiac problem in mind, especially if risk factors exist. Liaison with a medical center should be established before any emergency. Patients should be asked about pacemakers, implantable cardioverter-defibrillators, and circulatory assist devices. These devices indicate serious disease and suggest the need for further investigation about medications as well. The patient’s physician should be consulted about the need for antibiotic prophylaxis before dental treatment in those patients with circulatory assist devices. Many patients are at risk for emboli and are taking anticoagulants. Even if the patient is not taking an anticoagulant such as warfarin, questions should be asked about other antithrombotics, including aspirin. Some patients may have undergone cardiac transplantation, and this procedure carries lifelong treatment implications. Medical consultation is mandatory before any dental treatment." @default.
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• W136531871 date "1996-07-01" @default.
• W136531871 modified "2023-09-27" @default.
• W136531871 title "CONGESTIVE HEART FAILURE AND DISORDERS OF THE HEART BEAT" @default.
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• W136531871 doi "https://doi.org/10.1016/s0011-8532(22)00125-2" @default.
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