HYHO Heart Failure

Question 1

According to the AHA, what are the cardinal clinical symptoms of Heart Failure (HF)?

Answer 1

The cardinal clinical symptoms of HF are dyspnea and fatigue, as well as edema and rales.

Question 2

Define Stage A in the development of HF

Answer 2

At high risk for HF but without structural heart disease or symptoms of HF

e.g. Patients with hypertension, atherosclerotic disease, diabetes, obesity, metabolic syndrome

Question 3

Define Stage B in the development of HF

Answer 3

Structural heart disease but without signs or symptoms of HF

e.g. Patients with previous MI, LV remodeling including LVH and low EF, asymptomatic valvular disease

Question 4

Define Stage C in the development of HF

Answer 4

Structural heart disease with prior or current symptoms of HF

e.g. Patients with known structural heart disease and SOB, fatigue, reduced exercise tolerance

Question 5

Define Stage D in the development of HF

Answer 5

Refractory HF requiring specialized interventions

e.g. Patients who have marked symptoms at rest despite maximal medical therapy

Question 6

What are the benchmark values for ejection fraction?

Answer 6

Reduced: 40% or less
Preserved: 50% or more

Patients with values of 41% to 49% are classified as having borderline reduced ejection fraction

Question 7

What is expected with a finding of JVD?

Answer 7

JVP is >9 cm above the right atrium ( >4 cm above the sternal angle)

Question 8

What lab values would be diagnostic with a patient with HF?

Answer 8

Troponin > 0.01 ng/mL

BNP >900 (50-75 years) or >1800 (older than 75)

Question 9

What do Kerley B lines indicate?

Answer 9

Interstitial Edema

Question 10

What is the “ABCDE-F” approach

Answer 10

Systematic Approach:

Airway
-Check to see if the trachea is midline

Bone
-Look for fractures, metastasis

Cardiac
-Look to see if the heart is engaged

Diaphragm
-Check for free air under the diaphragm and pleural effusions

Extras
-identify all tubes and lines

Fields of the Lung
-Check the lung parenchyma for an atelectasis or consolidation

Question 11

What are some of the main osteopathic considerations for Acute Heart Failure?

Answer 11

• tissue texture changes over transverse processes
• rotated vertebrae

Other somatic dysfunctions include:

• Dependent extremity edema
• Rib dysfunction
• Flattened Diaphragm
• Scalene hypertonicity and tender points
• Pectoralis minor hypertonicity and tender points