Heart failure (HF) is a clinical condition during which cardiac function does not meet the body’s need, which results in fluid accumulation in the lungs, the liver, the gastrointestinal tract, and the arms and legs.
Heart failure results in significant morbidity and mortality, with a 1-year mortality rate of 7.2% and a 1-year hospitalization rate of 31.9% in patients with chronic heart failure, and in patients hospitalized for acute heart failure, these rates increase to 17.4% and 43.9%.
HF may affect only the left side (left-sided heart failure) or only the right side of the heart (right-sided heart failure), but most commonly both sides are involved.
- Heart failure with reduced ejection fraction (HFrEF), also called systolic failure: the left ventricle loses its ability to contract normally. The heart cannot pump with enough force to push enough blood into circulation.
- Heart failure with preserved ejection fraction (HFpEF), also called diastolic failure (or diastolic dysfunction): the left ventricle loses its ability to relax normally. The heart can't properly fill with blood during the resting period between each beat.
- Right-sided or right ventricular (RV) heart failure usually results from left-sided failure. When the left ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, ultimately damaging the heart's right side. When the right side loses pumping power, blood backs up in the body's veins. This usually causes swelling or congestion in the legs, ankles and swelling within the abdomen such as the gastrointestinal tract and liver (causing ascites). When right-sided heart failure results in congestion the term congestive heart failure (CHF) is sometimes used. Congestive heart failure is often used when symptoms of congestion require medical intervention.
Heart failure has been classified according to minor and major criteria, Framingham Criteria for Congestive Heart Failure..
The New York Heart association has classified HF according to limitations during physical activities, New York Heart Associations (NYHA) Functional Classification for Congestive Heart Failure.
- Peripheral edema, distended neck veins, shortness of breath, paroxysmal nocturnal dyspnea, severe orthopnea, fatigue, weakness?
- Have you experienced any recent weight changes?
- How many pillows do you sleep on at night?
- Do you have swollen ankles?
- What medications are you taking?
Patients with decompensated HF may present with acute complications.
⚠️ Do not provide elective dental care for individuals with decompensated HF.
Even minor surgical procedures have been associated with increased mortality within 30 days of hospitalization for HF.
⚠️ Do not provide elective dental care within 30 days after hospitalization for HF.
- Medical Disorders
- Oral Health Care Considerations
- Classifications and Definitions
- Boorsma EM, et al. Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment. Nat Rev Cardiol. 2020 Oct;17(10):641-655.
- Maggioni AP, et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2013 Jul;15(7):808-17.
- Murphy SP, et al Heart Failure With Reduced Ejection Fraction: A Review. JAMA. 2020 Aug 4;324(5):488-504. Erratum in: JAMA. 2020 Nov 24;324(20):2107.