HYHO HF

Question 1

What is the definition of HF?

Answer 1

• a complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood
• leads to dyspnea, fatigue, edema and rales
• many patients present without signs or symptoms

Question 2

Stages of HF

Answer 2

(sorry the pic was blurry)

Question 3

What is the dx of HF based on?

Answer 3

thorough hx and PE

Question 4

What are the categories of HF?

Answer 4

• HFrEF - LV EF of 40% or less (CAD is main cause; leads to LV dilation)
• HFpEF - LVEF of 50% or more (HTN is main cause; leads to LV hypertrophy)
• Patients with values of 41% to 49% are classified as having borderline reduced ejection fraction

Question 5

NYHA Functional Classes of HF

Answer 5

Question 6

When do you hear the following:

• AS
• MR
• AR
• MS
• VSD

Answer 6

Question 7

Signs and Sx of HF (flow chart)

Answer 7

Question 8

WHen looking at a CXR of a HF pt, what are you looking for?

Answer 8

Question 9

What is the grading scale of edema?

Answer 9

Question 10

What are the major criteria of the Framingham criteria of HF?

Answer 10

• PND
• Orthopnea
• Elevated JVP
• Crepitations
• S3
• Radiological evidence of cardiomegaly
• Radiological evidence of PE

*dx of HF requires the presence of 2 major criteria or 1 major and 2 minor criteria

Question 11

What are the minor criteria of the Framingham criteria of HF?

Answer 11

• extremity edema
• nigh cough
• exertional dyspnea
• hepatomegaly
• PE
• HR >120
• loss of >4.5 kg in 5 days following diuretic tx

*dx of HF requires the presence of 2 major criteria or 1 major and 2 minor criteria

Question 12

If a pt. presents with acute onset and progressed rapidly over a few minutes, what is your ddx?

Answer 12

Question 13

If pt presents with gradually onset and progressed rapidly over hours to days, what is your ddx?

Answer 13

Question 14

If a pt presents with gradually onset and progressed relentlessly over wks/months, what if your ddx?

Answer 14

Question 15

If a pt presents with gradually onset of sx and progressed relentlessly over months/yrs?

Answer 15

Question 16

HF dx by the specialist (flow chart)

Answer 16

Question 17

What parasympathetics are associated with HF? tenderpoints?

Answer 17

• vagus n., OA, AA, C2
  
  • increased tone –> bradycardia
• TPs: tissue texture changes over cervical pillars, rotated vertebrae, compression of occipitomastoid sutures as well as occipito-atlantoid joint

Question 18

What sympathetics are involved in HF? tenderpoints?

Answer 18

• T1-5
  
  • increased tone –> tachycardia
• TPs: tissue texture changes over TPs, rotated vertebrae

Question 19

What motor elements are involved in HF? tender points?

Answer 19

• C3-5 (phrenic n.)
  
  • irritation due to lung proximity
• TPs: tissue texture changes over cervical pillars, rotated vertebrae

Question 20

What are some common SDs seen in HF?

Answer 20

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

Question 21

What are some 2 minute treatments for HF? 5 minute? Extended Tx?

Answer 21

1. LE - pedal pump
2. Rib raising
3. Extended
   
   1. Head -
      
      1. OA relase or V spread (OA)
      2. decreased CRI - CV4 hold
   2. Abdomen - diaphragm
   3. Doming technique
   4. Thoracolumbar junction - ME, MFR, HVLA
   5. Rib dysfunction - ME
   6. Cervical - C2, C3-C5 (MFR, ME, FPR)
   7. LE/UE - effleurage
   8. Cervical - scalenes (CS, ME)
   9. UE - pectoralis minor (CS, MFR)
   10. Abdomen/other/viscerosomatic - chapman’s reflex for heart

Question 22

What are signs/sx of Acute decompensated HF?

Answer 22

Question 23

What are diagnostic studies for acute decompensated HF?

Answer 23

Question 24

What are txs for acute decompensated HF?

Answer 24

sorry didn’t feel like typing it up

Question 25

What are the most common tx modalities for HFpEF?

Answer 25

* tx should target associated conditions (ex. HTN) * Unlike HFrEF, beta blockers, ACE inhibitors, ARBs, and cardiac resynchronization are not effective in HFpEF

Question 26

What are the most common tx modalities for HFrEF?

Answer 26

* management of contributing factors and associated conditions, lifestyle modification, pharmacologic therapy, device therapy if indicated, cardiac rehabilitation, and preventive care