CASE REPORT

DentalmanagementofpatientwithCongestiveheartfailure:
A case report and a review of the literature.

Arjay Nino S. Dulay

Department of Dentistry, University of the Philippines – Philippine General Hospital, Manila Philippines
Univeristy of the East, College of Dentistry, Manila Philippines

KEYWORDS Summary Congestive heart failure (CHF) is a condition in which

Congestive Heart the heart's function as a pump is inadequate to deliver oxygen rich
Failure; blood to the body. Congestive heart failure can be caused by diseases
Compensated that weaken the heart muscle, diseases that cause stiffening of the
CHF; heart muscles, or diseases that increase oxygen demand by the body
Digoxin tissue beyond the capability of the heart to deliver adequate oxygen-
rich blood. The prevalence of heart failure increases with age; it is
approximately 1% at age 50 and 5% at age 75.7 Four out of five cases
of heart failure occur in persons 65 years of age or older.6 Thus the
condition requires a more specific management in dealing with the
dental procedure the patient has to undergo. This case study
presents a 67- year old male patient suffering from Congestive heart
failure of 4 year duration, who has undergone an elective dental
surgical procedure.

Introduction

Congestive Heart Failure is a clinical cases of heart failure occur in persons 65

syndrome that results from the progressive
process of remodeling, in which mechanical
and biochemical forces alter the size, shape,
and function of the ventricle’s ability to
pump enough oxygenated blood to meet the
body’s metabolic requirements. CHF
presents the end stage of many underlying
types of cardiovascular diseases that
ultimately lead to heart failure. CHF may be
defined as a systemic syndrome produced by
failing myocardium or a significant increase
in the left-ventricular end-diastolic pressure
despite normal cardiac function.4
The prevalence of heart failure
increases with age; it is approximately 1% at
age 50 and 5% at age 75.7 Four out of five
years of age or older.6 Heart failure is the
most common cause of hospitalization in this
age group, and nearly half of elderly patients
with a discharge diagnosis of heart failure
are readmitted within 6 months.6 Men are
more likely to be affected by heart failure
than are women, probably because the
incidence of ischemic heart disease is
greater in men than in women.1, 2 Roughly 9
out of 10 patients with a diagnosis of heart
failure survive for 1 year.3 However, only 5
out of 10 patients are alive 5 years after
diagnosis, and the quality of life is impaired
in many of these patients.3 Death is sudden
in 40% of patients, suggesting that it is the
result of serious ventricular arrhythmia.2
 Congestive heart failure is the end
stage of disproportion between the required
hemodynamic load and the capacity of the
heart to handle the load. This imbalance can
occur with chronic increase in the load or
damage to the myocardium. Chronic
congestive heart failure usually evokes
compensatory adjustments consisting of
increased peripheral resistance,
redistribution of blood flow to the heart and
brain, and an increased efficiency of oxygen
utilization by the tissues.4
Heart failure usually occurs in
stages.8 The first stage involves ventricular
dysfunction with the development of a
gallop rhythm. The second stage consists of
congestive failure with dyspnea, pulmonary
congestion, and peripheral edema. The third
stage, termed compensated heart failure, is
the control or elimination of the clinic signs
and symptoms of congestion by medical
therapy. 4
Patients with untreated heart failure
or poorly managed response to it are at high
risk during dental treatment for such
complication as infection, cardiac arrest,
cerebrovascular accident, myocardial
infarction. 4
Case report
A 67-year old male patient came to the
infirmary complaining of pain on the right
anterior area of his maxillary jaw. According
to the patient of 6 months duration and is
throbbing and intermittent in nature; the
patient was diagnosed with chronic
periapical infection of tooth number 14 with
chronic periodontitis. Past medical history
revealed that the patient is suffering from
hypertension, chronic obstructive
pulmonary disorder, and chronic kidney
insufficiency; and the patient was diagnosed
with congestive heart failure 4 years prior.
Patient is under the care of a physician and
regularly attends check up in an outpatient
setting. The patient is also religiously taking
several medications indicated to control
debilitating symptoms of the condition.
The extraoral examination was
within normal limits with no evidence of
lymphadenopathy. Intraoral examination
revealed several teeth with large restoration.
His periodontal condition and oral hygiene is
relatively poor.
Adequate recommendation from the
patient’s attending physician was needed to
push through with the elective dental
procedure. The patient was given an early
morning appointment. Patient was given
adequate but minimal anesthetic; when the
effect of the anesthetic was profound and
extraction of tooth 14 was done
atraumatically as possible.
Patient was prescribed with
analgesic and was given appropriate post
operative instructions prior to discharge. A
week after the surgery patient was seen for
check up; extraction site is site was healing
normally and without complications.
Discussion
The New York Heart Association has devised
a classification of heart disease grades the
severity of CHF.5 The following classification
is useful in following the course of disease
and assessing the effects of therapy. It can
also be used to aid in dental management of
patients.
Class I: No limitation of physical activity. No
dyspnea, fatigue, or palpitations with
ordinary physical activity.
Class II: Slight limitation of physical activity.
These patients have fatigue, palpitations, and
dyspnea with ordinary physical activity but
comfortable at rest.
Class III: Marked limitation of activity. Less
than ordinary physical activity results in
symptoms, but patients are comfortable in
rest.
Class IV: Symptoms are present at rest, and References
any physical exertion exacerbates the
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Disease and Stroke Statistics—2004
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