Heart Failure
- C.S.N.Vittal
Definition
• HEART FAILURE IS A CLINICALHEART FAILURE IS A CLINICAL
SYNDROME IN WHICH HEART CANNOTSYNDROME IN WHICH HEART ...
Possible types
Excessive work load on myocardium
(pressure and volume loading)
Primary alterations in myocardial
performan...
Pathophysiology
HEART IS A PUMP WITH OUTPUTHEART IS A PUMP WITH OUTPUT
PROPORTIONAL TO FILLING VOLUME &PROPORTIONAL TO FIL...
Cardiac output is determined by...
• PRELOAD
• AFTERLOAD
• CONTRACTILITY
• HEART RATE
Systemic oxygen content is...
•DECRE...
General manifestations
Pulmonary and systemic venous congestion
Decreased systemic perfusion
Operation of several potentia...
Aetiology
Fetus
Severe anemia
SVT
Complete heart block
CHD
High output failuers (A-V malformations,
teretoma)
Aetiology
Preterm
Fluid overload
Bronchopulmonary dysplasis
Full term neonate
Asphyxia
AV - malformations
Lt. sided obstru...
Aetiology
Infant or Toddler
Lt to Rt Shunts
AV malformations
Metabolic cardiomyopathy
Acute hypertension (hemolytic
uremic...
Aetiology
Children & Adolescents
Rheumatic fever
Acute hypertension ( glomerulonephritis)
Viral myocarditis
Thyrotoxicosis...
Compensatory mechanisms
•SYMPATHETIC STIMULATION
•INCREASED HEART RATE
•INCREASED CONTRACTILITY
•REDISTRIBUTION OF BLOOD
D...
Prolonged sympathetic
stimulation may lead to..
INCREASED OXYGEN DEMAND
INCREASED AFTER LOAD
HYPERMETABOLISM
MYOCARDIAL TO...
Precipitating Causes of
CHF
INFECTIONS
ANEMIA
INFECTIVE ENDOCARDITIS
EXCESSIVE PHYSICAL ACTIVITY
SODIUM OVER LOAD
ARRHYTHM...
TYPES OF HEART FAILURE
SYSTOLIC OR DIASTOLICSYSTOLIC OR DIASTOLIC
ACUTE OR CHRONIC
RIGHT OR LEFT
FORWARD OR BACKWARD
HIGH ...
Clinical Features
HISTORY
• INFANTS
• POOR FEEDING
• POOR WEIGHT GAIN
• DYSPNOEA WHILE
SUCKING
• PERSPIRATION
Clinical Features
HISTORY
• OLDER CHILDRE
BREATHLESSNESS
ORTHOPNEOEA
EASY FATIGABILITY
EDEMA
ABDOMINAL PAIN
ANOREXIA
COUGH
PULMONARY
VENOUS
CONGESTION
TACHYPNEA
DYSPNEA
ORTHOPNEA
COUGH
WHEEZING
SYSTEMIC
VENOUS
CONGESTION
• EDEMAHEPAT
OMEGALYRAIS...
Clinical Signs of CHF
Cardiomegaly
Gallop sounds
Coarse rales in the lung bases
Sputum frothy and blood tinged
Hydrothorax...
Framingham Criteria for CHF
Major Criteria
PND/ orthopnoea
JVP
Rales
Cardiomegaly
Ac. pul. edema
S3 gallop
CT > 25 sec.
...
DIAGNOSIS
CXR Cardiomegaly
ECG
Chamber hypertrophy, arrhythmias,
myocarditis
ECHO Detection of actual lesion
Ventricular
F...
Management of CHF - General
Rest Reduces COP
Oxygen Improves oxygenation in pulm. edema
Na and Fluid
restriction
Decreases...
Management of CHF -
Inotorpes
Digoxin
Inhibits membrane Na+K+ ATPase,
Increases intracellular Ca++, Improves cardiac
contr...
Management of CHF - Afterload reducing agents
Hydralazine Arterial vasodialatation
Nitroprusside Arterial & venous relaxat...
Digitalization
PO : Half initially followed by 1/4th
every 8 - 12 hrs X 2
Dose:
Preterm : 20 microG/kg
Term neonate: 2-=30...
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Congestive Heart Failure in Children

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Congestive Heart Failure in Children

  1. 1. Heart Failure - C.S.N.Vittal
  2. 2. Definition • HEART FAILURE IS A CLINICALHEART FAILURE IS A CLINICAL SYNDROME IN WHICH HEART CANNOTSYNDROME IN WHICH HEART CANNOT PUMP AT A RATE COMMENSURATEPUMP AT A RATE COMMENSURATE • WITH REQUIREMENTS OFWITH REQUIREMENTS OF • TISSUE METABOLISM.TISSUE METABOLISM.
  3. 3. Possible types Excessive work load on myocardium (pressure and volume loading) Primary alterations in myocardial performance (inflammatory disease) Metabolic derangements Combinations of these
  4. 4. Pathophysiology HEART IS A PUMP WITH OUTPUTHEART IS A PUMP WITH OUTPUT PROPORTIONAL TO FILLING VOLUME &PROPORTIONAL TO FILLING VOLUME & INVERSELY PROPORTIONAL TOINVERSELY PROPORTIONAL TO RESISTANCE AGAINST WHICH IT PUMPS .RESISTANCE AGAINST WHICH IT PUMPS . SYSTEMIC OXYGEN TRANSPORT ISSYSTEMIC OXYGEN TRANSPORT IS PRODUCT OF COP AND SYSTEMIC OXYGENPRODUCT OF COP AND SYSTEMIC OXYGEN CONTENTCONTENT
  5. 5. Cardiac output is determined by... • PRELOAD • AFTERLOAD • CONTRACTILITY • HEART RATE Systemic oxygen content is... •DECREASED IN ANEMIA & HYPOXIA •INCREASED IN HYPERMETABOLIC STATES
  6. 6. General manifestations Pulmonary and systemic venous congestion Decreased systemic perfusion Operation of several potentially adaptive mechanisms increased adrenal activity fluid retention ventricular dilatation and hypertrophy
  7. 7. Aetiology Fetus Severe anemia SVT Complete heart block CHD High output failuers (A-V malformations, teretoma)
  8. 8. Aetiology Preterm Fluid overload Bronchopulmonary dysplasis Full term neonate Asphyxia AV - malformations Lt. sided obstructive lesions TGA Large shunt diseases Viral myocarditis
  9. 9. Aetiology Infant or Toddler Lt to Rt Shunts AV malformations Metabolic cardiomyopathy Acute hypertension (hemolytic uremic syndrome SVT Kawasaki disease Post operative repair of CHDs
  10. 10. Aetiology Children & Adolescents Rheumatic fever Acute hypertension ( glomerulonephritis) Viral myocarditis Thyrotoxicosis Anemias Eg. Sickle cell disease Infective Endocarditis Cor pulmonale ( cystic fibrosis) Cardiomyopathy Cancer therapy (radiation, adriamycin)
  11. 11. Compensatory mechanisms •SYMPATHETIC STIMULATION •INCREASED HEART RATE •INCREASED CONTRACTILITY •REDISTRIBUTION OF BLOOD DUE TO PERIPHERAL VASOCONSTRICTION
  12. 12. Prolonged sympathetic stimulation may lead to.. INCREASED OXYGEN DEMAND INCREASED AFTER LOAD HYPERMETABOLISM MYOCARDIAL TOXICITY DECREASED GIT RENAL HEPATIC FLOW
  13. 13. Precipitating Causes of CHF INFECTIONS ANEMIA INFECTIVE ENDOCARDITIS EXCESSIVE PHYSICAL ACTIVITY SODIUM OVER LOAD ARRHYTHMIAS
  14. 14. TYPES OF HEART FAILURE SYSTOLIC OR DIASTOLICSYSTOLIC OR DIASTOLIC ACUTE OR CHRONIC RIGHT OR LEFT FORWARD OR BACKWARD HIGH OUTPUT OR LOW OUTPUT
  15. 15. Clinical Features HISTORY • INFANTS • POOR FEEDING • POOR WEIGHT GAIN • DYSPNOEA WHILE SUCKING • PERSPIRATION
  16. 16. Clinical Features HISTORY • OLDER CHILDRE BREATHLESSNESS ORTHOPNEOEA EASY FATIGABILITY EDEMA ABDOMINAL PAIN ANOREXIA COUGH
  17. 17. PULMONARY VENOUS CONGESTION TACHYPNEA DYSPNEA ORTHOPNEA COUGH WHEEZING SYSTEMIC VENOUS CONGESTION • EDEMAHEPAT OMEGALYRAIS ED JVPANOREXI AABDOMINAL PAIN
  18. 18. Clinical Signs of CHF Cardiomegaly Gallop sounds Coarse rales in the lung bases Sputum frothy and blood tinged Hydrothorax Hepatojugular reflux (Pasteur-Randot reflux) Ascites
  19. 19. Framingham Criteria for CHF Major Criteria PND/ orthopnoea JVP Rales Cardiomegaly Ac. pul. edema S3 gallop CT > 25 sec. Hepatojugular reflux Minor Criteria Ankle edema Night cough Dyspnoea on exertion Hepatomegaly Pleural effusion Vital capacity  to 1/3 max. Tachycardia( > 120/m) Major or Minor : Wt. loss > 4.5 kg in 5 days with treatment Diagnosis of CHF : 2 major OR 1 major + 2 minor
  20. 20. DIAGNOSIS CXR Cardiomegaly ECG Chamber hypertrophy, arrhythmias, myocarditis ECHO Detection of actual lesion Ventricular Function BNP
  21. 21. Management of CHF - General Rest Reduces COP Oxygen Improves oxygenation in pulm. edema Na and Fluid restriction Decreases vascular congestion and preload Diuretics - frusemide Reduces preload, vasodialatation Combination DCT diuretic Better salt excretion
  22. 22. Management of CHF - Inotorpes Digoxin Inhibits membrane Na+K+ ATPase, Increases intracellular Ca++, Improves cardiac contractility and myocardial O2 consumption Dopamine Reduces myocardial norepinephrine, direct beta receptor action - increase in systemic BP Dobutamine Beta 1 agonist, often used with dopamine Amrinone Non-sympathomimetic, non-cardiac glycoside with inotropic effect, also - vasodialatation
  23. 23. Management of CHF - Afterload reducing agents Hydralazine Arterial vasodialatation Nitroprusside Arterial & venous relaxation, reduces preload also Captopril/ enalapril ACE Inhibitors, reduce Angiotensin II production Prazosin Oral alpha adrenergic blocker, arterial & venous dialatation, reduces preload also Mechanical Counter pulasations Improves coronary flow, afterload Partial Lt. ventriculotomy _ mitral valve Improves Laplace relationship by less wall tension
  24. 24. Digitalization PO : Half initially followed by 1/4th every 8 - 12 hrs X 2 Dose: Preterm : 20 microG/kg Term neonate: 2-=30 mcg/kg Adolescent : 0.5 - 1.0 mg in div doses IV : 75% of oral dose
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