osteopathic approach to heart failure exam questio
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Osteopathic Approach to Heart Failure
Exam Questions and Correct Answers,
100% Correct. Updated Fall 2024/2025.
Heart Failure
A clinical syndrome due to a congenital or acquired abnormality of cardiac structure and/or function,
resulting in an inability of the heart to pump blood at a sufficient rate and volume to meet the metabolic
demands of the tissues without maintaining abnormally elevated diastolic pressures or volumes.
Stages of Heart Failure
Classified into Stage A (high risk but no structural disease or symptoms), Stage B (structural heart disease
but no symptoms), Stage C (structural heart disease with symptoms), and Stage D (refractory HF
requiring special interventions).
Epidemiology
HF affects 20% of US adults over their lifetime, with prevalence rates increasing with age. HF contributes
to 280,000 deaths annually in the US.
Stroke Volume
Total volume of blood ejected by the ventricle; determined by end diastolic ventricular volume and
myocyte contractility.
Ejection Fraction (EF)
Ratio of stroke volume relative to the end diastolic volume; normal EF is >60%.
Diastolic Dysfunction
Condition where the end diastolic pressure is increased, resulting in decreased stroke volume but a
relatively normal EF.
Impaired Systolic Function
One of the etiologies of HF, including ischemic damage, hypertension, valvular disease, volume overload,
and dilated cardiomyopathies.
Impaired Diastolic Function
Includes myocardial hypertrophy, ischemic fibrosis, restrictive cardiomyopathy, mechanical
abnormalities, pulmonary heart disease, and high-output states.
Risk Factors
Conditions leading to alterations in left ventricular structure or function predisposing a patient to
develop HF.
, Compensatory Mechanisms
Activation of sympathetic nervous system, renin-angiotensin-aldosterone system, natriuretic hormones,
and baroreceptors in kidneys to maintain homeostasis in HF.
Coronary Artery Disease (CAD)
60%-75% of HF cases in industrialized countries are secondary to CAD, with hypertension contributing to
75% of HF cases.
Clinical Manifestations
Cardinal symptoms of HF include fatigue, edema, and dyspnea, with fatigue due to low cardiac output
and dyspnea to pulmonary congestion.
Orthopnea
Dyspnea that occurs when lying flat due to sudden increase in venous return from the splanchnic
circulation and lower extremities into the central circulation.
Dependent Edema
Edema associated with HF that is typically dependent on postural positioning and more common in the
lower extremities.
Physical Examination
Findings vary based on the cause and severity of HF, with patients in mild HF appearing uncomfortable
lying flat and those in severe HF needing to sit upright due to labored breathing.
Cardiac cachexia
Severe chronic HF with marked weight loss and poor prognosis.
Sinus tachycardia
Likely present in HF with normal or high systolic blood pressure in early stages.
Systolic blood pressure
Reduced in advanced HF due to severe LV dysfunction.
Rales
Result from transudate accumulation in alveoli in HF.
Cheyne-Stokes respiration
Represents respiratory center insensitivity to arterial PCO2 in HF.
Ascites
Fluid accumulation in the abdomen, a sign of advanced HF.
Point of maximal impulse (PMI)
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