This document discusses congestive cardiac failure in infants and children. It describes the causes, signs, and management of cardiac failure. The main causes in infants include congenital heart disease, arrhythmias like supraventricular tachycardia, and myocarditis. Signs of left-sided failure include tachypnea and hepatomegaly while signs of right-sided failure include hepatomegaly and facial edema. Management involves reducing cardiac workload, improving contractility, and treating the underlying cause. Diuretics, vasodilators, inotropes, and drugs that suppress the renin-angiotensin system are used. Prognosis depends on the cause, with mortality from cardiac failure being high
Hydrops fetalis is a severe condition where excess fluid builds up in fetal tissues. It can be caused by immune or non-immune factors. Immune hydrops is caused by fetal anemia from blood incompatibility between mother and fetus, while non-immune hydrops can result from conditions like infections, heart defects, or genetic abnormalities. Symptoms include excess amniotic fluid and swelling visible on ultrasound. After birth, symptoms are pale skin, edema, enlarged organs, and respiratory distress. Diagnosis involves ultrasounds, blood tests, and other procedures to investigate potential causes. Treatment depends on the underlying cause but may include help with breathing, removing excess fluid, and kidney support.
This document provides an overview of neonatal jaundice, including its epidemiology, pathophysiology, etiology, clinical presentation, management, and complications. Key points include:
- Neonatal jaundice is common, occurring in 50-80% of newborns, and is usually harmless. It is caused by elevated bilirubin levels in the blood.
- Jaundice can be physiological or pathological. The causes and management differ depending on whether the elevated bilirubin is conjugated or unconjugated.
- Evaluation involves clinical exam, bilirubin levels, and other tests to determine the underlying cause. Management includes phototherapy, exchange transfusion, or pharmacotherapy depending on
This document discusses heart failure in children. It defines heart failure as the heart's inability to pump enough blood to meet the body's needs. The key factors that affect cardiac performance are preload, afterload, and contractility. In children, common causes of heart failure include congenital heart defects, cardiomyopathy, and acquired conditions like myocarditis. Symptoms depend on whether left-sided or right-sided heart failure predominates. Treatment focuses on correcting underlying causes, diet modification, diuretics to reduce preload, digitalis to improve contractility, and dilators to reduce afterload. Imaging studies like echocardiograms are important for diagnosis.
This document discusses prematurity and intrauterine growth retardation (IUGR). Prematurity is defined as birth before 37 weeks gestation. IUGR refers to poor growth in the womb. Both conditions increase neonatal morbidity and mortality. The document outlines classifications of prematurity and IUGR. It also discusses their incidence, causes, assessment, associated diseases in low birthweight infants, and care of preterm infants. Proper care includes thermal control, oxygen therapy, fluid management, nutrition, and infection prevention. Long term outcomes depend on gestational age and birthweight, with more prematurity and lower weight correlating to worse outcomes.
This document provides information on neonatal jaundice, including definitions, causes, pathophysiology, assessment, diagnosis, signs and symptoms, complications, and management. The key points are:
- Neonatal jaundice is the yellow discoloration of skin and mucous membranes due to high bilirubin levels in newborns.
- It can be physiological, due to increased red blood cell breakdown and immature liver function in newborns, or pathological, due to excessive hemolysis or liver/gallbladder issues.
- Assessment involves history, physical exam, and lab tests to determine bilirubin levels and underlying cause. High bilirubin levels can cause the serious complication of
The document discusses the Patent Ductus Arteriosus (PDA), which is a persistent opening between the pulmonary artery and the aorta that usually closes shortly after birth. It provides details on the epidemiology, pathophysiology, clinical features, diagnostic measures, and management of PDA. PDA is more common in preterm infants and left untreated can cause complications like pulmonary hypertension, congestive heart failure, and infections. Treatment involves the use of medications like indomethacin or ibuprofen to close the opening or surgical ligation if medications fail. Nursing care focuses on relieving respiratory distress, improving cardiac output and oxygenation, adequate nutrition, and preventing infections.
simlpe approach to anemia in children , how to diagnose anemia in kids ,types of anemias ,causes of anemia , iron deficeincy anemia, hemolytic anemias , laboratory tests in anemia ,
Bronchiolitis is an inflammatory disease of the small airways caused primarily by Respiratory Syncytial Virus (RSV) in infants under 1 year old. It leads to obstruction of the small airways due to inflammation, mucus production, and edema. Clinically, infants present with rhinorrhea, cough, tachypnea, wheezing and respiratory distress. Chest X-ray may show hyperinflated lungs. Management is supportive with oxygen, hydration and sometimes bronchodilators. Most infants recover within 2 weeks but some may develop long-term wheezing.
Hydrops fetalis is a severe condition where excess fluid builds up in fetal tissues. It can be caused by immune or non-immune factors. Immune hydrops is caused by fetal anemia from blood incompatibility between mother and fetus, while non-immune hydrops can result from conditions like infections, heart defects, or genetic abnormalities. Symptoms include excess amniotic fluid and swelling visible on ultrasound. After birth, symptoms are pale skin, edema, enlarged organs, and respiratory distress. Diagnosis involves ultrasounds, blood tests, and other procedures to investigate potential causes. Treatment depends on the underlying cause but may include help with breathing, removing excess fluid, and kidney support.
This document provides an overview of neonatal jaundice, including its epidemiology, pathophysiology, etiology, clinical presentation, management, and complications. Key points include:
- Neonatal jaundice is common, occurring in 50-80% of newborns, and is usually harmless. It is caused by elevated bilirubin levels in the blood.
- Jaundice can be physiological or pathological. The causes and management differ depending on whether the elevated bilirubin is conjugated or unconjugated.
- Evaluation involves clinical exam, bilirubin levels, and other tests to determine the underlying cause. Management includes phototherapy, exchange transfusion, or pharmacotherapy depending on
This document discusses heart failure in children. It defines heart failure as the heart's inability to pump enough blood to meet the body's needs. The key factors that affect cardiac performance are preload, afterload, and contractility. In children, common causes of heart failure include congenital heart defects, cardiomyopathy, and acquired conditions like myocarditis. Symptoms depend on whether left-sided or right-sided heart failure predominates. Treatment focuses on correcting underlying causes, diet modification, diuretics to reduce preload, digitalis to improve contractility, and dilators to reduce afterload. Imaging studies like echocardiograms are important for diagnosis.
This document discusses prematurity and intrauterine growth retardation (IUGR). Prematurity is defined as birth before 37 weeks gestation. IUGR refers to poor growth in the womb. Both conditions increase neonatal morbidity and mortality. The document outlines classifications of prematurity and IUGR. It also discusses their incidence, causes, assessment, associated diseases in low birthweight infants, and care of preterm infants. Proper care includes thermal control, oxygen therapy, fluid management, nutrition, and infection prevention. Long term outcomes depend on gestational age and birthweight, with more prematurity and lower weight correlating to worse outcomes.
This document provides information on neonatal jaundice, including definitions, causes, pathophysiology, assessment, diagnosis, signs and symptoms, complications, and management. The key points are:
- Neonatal jaundice is the yellow discoloration of skin and mucous membranes due to high bilirubin levels in newborns.
- It can be physiological, due to increased red blood cell breakdown and immature liver function in newborns, or pathological, due to excessive hemolysis or liver/gallbladder issues.
- Assessment involves history, physical exam, and lab tests to determine bilirubin levels and underlying cause. High bilirubin levels can cause the serious complication of
The document discusses the Patent Ductus Arteriosus (PDA), which is a persistent opening between the pulmonary artery and the aorta that usually closes shortly after birth. It provides details on the epidemiology, pathophysiology, clinical features, diagnostic measures, and management of PDA. PDA is more common in preterm infants and left untreated can cause complications like pulmonary hypertension, congestive heart failure, and infections. Treatment involves the use of medications like indomethacin or ibuprofen to close the opening or surgical ligation if medications fail. Nursing care focuses on relieving respiratory distress, improving cardiac output and oxygenation, adequate nutrition, and preventing infections.
simlpe approach to anemia in children , how to diagnose anemia in kids ,types of anemias ,causes of anemia , iron deficeincy anemia, hemolytic anemias , laboratory tests in anemia ,
Bronchiolitis is an inflammatory disease of the small airways caused primarily by Respiratory Syncytial Virus (RSV) in infants under 1 year old. It leads to obstruction of the small airways due to inflammation, mucus production, and edema. Clinically, infants present with rhinorrhea, cough, tachypnea, wheezing and respiratory distress. Chest X-ray may show hyperinflated lungs. Management is supportive with oxygen, hydration and sometimes bronchodilators. Most infants recover within 2 weeks but some may develop long-term wheezing.
Neonatal jaundice is a condition in newborns marked by high levels of bilirubin in the blood, causing yellowing of the skin and whites of the eyes. Bilirubin levels are often higher in neonates due to increased red blood cell breakdown, liver immaturity, and bacterial colonization. Without treatment, hyperbilirubinemia can cause permanent brain damage known as kernicterus. Proper monitoring and treatment is important to prevent dangerous bilirubin levels in newborns.
This document provides information on respiratory distress syndrome (RDS), including its definition, etiology, pathophysiology, signs and symptoms, investigations, management, nursing diagnoses, and nursing interventions. RDS is a disease in newborns related to deficiency of surfactant in the lungs, leading to respiratory distress. Key factors that can decrease surfactant and contribute to RDS include prematurity, hypothermia, asphyxia, and having a diabetic mother. Management involves supportive care like oxygen supplementation and ventilation support if needed, as well as more aggressive treatments like surfactant replacement therapy for very preterm infants.
Please find the power point on Phototherapy in jaundice . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This document discusses iron deficiency anemia (IDA) in children. It begins by defining anemia and listing the WHO thresholds used to define anemia in different age groups. It then covers the etiological, morphological and pathophysiological classifications of anemia. Under the etiological classification, it describes anemias caused by blood loss, impaired red blood cell formation, and excessive red blood cell destruction. It also discusses the clinical features, laboratory diagnosis, treatment, complications and prevention of IDA in children.
This document discusses neonatal seizures, including their classification, causes, diagnosis, and management. It defines neonatal seizures as clinical manifestations of underlying neurological dysfunction in newborns. Seizures are classified as subtle, tonic, clonic, or myoclonic. Common causes include hypoxic-ischemic encephalopathy, intracranial hemorrhage, infections, and metabolic disturbances. Diagnosis involves a medical history, physical exam, and investigations like blood tests, imaging, EEG, and CSF examination. Initial management focuses on stabilization, treating correctable causes like hypoglycemia and hypocalcemia, and anti-seizure medications if needed. Nursing care includes emergency response, psychosocial support for family members, and
Cor pulmonale, or right heart failure, is caused by high blood pressure in the pulmonary artery and right ventricle due to conditions that restrict pulmonary blood flow such as chronic lung diseases. It develops when pulmonary hypertension leads to enlargement and failure of the right ventricle. Symptoms include shortness of breath, leg swelling, and fatigue. Diagnosis involves physical exam, imaging like echocardiogram and chest x-ray, and assessing pulmonary pressures. Treatment focuses on managing the underlying lung condition, giving diuretics and vasodilators, and may involve oxygen therapy or lung transplantation in severe cases.
Tetralogy of Fallot is a congenital heart defect combining four defects: a ventricular septal defect, pulmonary stenosis, an overriding aorta, and right ventricular hypertrophy. It is the most common cyanotic heart defect seen in 6-10% of congenital heart diseases. Affected individuals experience cyanosis and fatigue due to reduced oxygen circulation. Diagnosis involves physical exams, echocardiograms, and x-rays showing the boot-shaped heart. Treatment includes medical management of hypoxic spells as well as surgical procedures like the Blalock-Taussig shunt or complete repair to improve oxygen circulation.
This document discusses jaundice in newborns. It defines jaundice as a yellowing of the skin caused by high bilirubin levels. Jaundice is common in newborns and usually resolves on its own, but sometimes requires treatment. The document covers physiological vs pathological jaundice, clinical assessment of jaundice, risk factors, potential complications like kernicterus, treatment options like phototherapy and exchange transfusion.
This document discusses dehydration in pediatrics. It defines dehydration and explains its pathophysiology and types based on severity and fluid/electrolyte loss. Causes of dehydration include diarrhea, vomiting, excessive sweating, diabetes and burns. Diagnosis involves blood and urine tests to check electrolyte levels. Signs and symptoms range from mild thirst to severe complications depending on the percentage of fluid loss. Treatment involves oral or IV fluid replacement depending on severity. Nursing care focuses on monitoring fluid intake and output, providing skin care and educating families on prevention.
Neonatal acute respiratory distress syndrome (RDS) is caused by surfactant deficiency in premature infants. Surfactant is produced in the lungs beginning at 24 weeks gestation and helps lower surface tension to prevent alveolar collapse. Preemies are at risk for RDS due to incomplete lung development and surfactant production. Treatment includes supportive care like CPAP, surfactant replacement therapy, and mechanical ventilation if needed. With treatment and lung maturation, symptoms typically improve within 3-5 days.
Myocarditis is an inflammatory disease of the heart muscle that can be caused by infectious or non-infectious triggers. It has a variable clinical presentation ranging from mild symptoms to life-threatening conditions. The diagnosis is challenging due to the heterogeneity of symptoms but can involve electrocardiogram, cardiac biomarkers, echocardiogram, cardiac MRI and endomyocardial biopsy. About half of acute cases resolve in 2-4 weeks but some develop heart failure or arrhythmias. Treatment focuses on supporting heart function and managing symptoms while the disease runs its course.
This document outlines a presidential action plan for infectious endocarditis in children. It begins with definitions of infective endocarditis and discusses the epidemiology, pathogenesis, clinical features, diagnosis, treatment and prevention. Key points include that infective endocarditis is less common in children than adults but is increasing in those with cardiac surgery or conditions. Common causes are streptococcal and staphylococcal species. Clinical features may include fever, heart murmur and embolic phenomena. Echocardiography is important for diagnosis but blood cultures are also needed under the modified Duke criteria. Surgery may be indicated for complications such as heart failure or abscesses.
Infective endocarditis is inflammation of the heart valves caused by bacterial infection. It is often a complication of congenital or rheumatic heart disease. Common causative organisms include streptococci and staphylococci. Risk factors include prior heart disease, dental/medical procedures, and intravenous drug use. Symptoms include fever, chills, weight loss and heart murmurs. Echocardiography and blood cultures help diagnose. Treatment involves antibiotics for 4-6 weeks. Surgery may be needed for severe valve damage or persistent infection. Prognosis remains serious despite treatment, with 20-25% mortality and high morbidity rates.
Respiratory distress syndrome is a condition in premature infants caused by a lack of surfactant in the lungs. Surfactant is needed to keep the alveoli open during breathing. Without it, lungs collapse during exhalation due to surface tension. This causes respiratory failure. Risk factors include prematurity, meconium aspiration, or maternal complications. Diagnosis involves assessing breathing rate, lung sounds, oxygen needs and chest x-rays. Treatment focuses on providing oxygen, medications, and supportive care until the lungs mature enough to produce surfactant.
Cardiac arrest refers to the sudden cessation of cardiac activity and can lead to death if not treated. It is usually caused by conditions that disrupt the heart's electrical system such as coronary artery disease or structural heart abnormalities. Risk factors include a family history of sudden cardiac death, previous heart issues, and lifestyle factors like smoking and obesity. Diagnosis involves evaluating the patient's history, ECG, echocardiogram, and blood work. Treatment includes CPR, defibrillation, cardiac catheterization, bypass surgery, and medication to control arrhythmias and heart disease. Nursing care focuses on monitoring the patient's condition, providing oxygen, and educating on preventing future cardiac events.
Pediatric meningitis and encephalitis 2021Imran Iqbal
This document provides an overview of pediatric meningitis and encephalitis, including:
1. It discusses the types, epidemiology, clinical features, diagnosis, management, complications, prognosis and prevention of acute bacterial meningitis and viral meningoencephalitis.
2. Key points include the importance of vaccination, the clinical signs and symptoms of each condition, and treatments involving antibiotics, antivirals and supportive care.
3. Rare conditions like cerebral malaria, tuberculous meningitis and SSPE are also briefly covered.
Acute glomerulonephritis is an acute inflammation of the renal glomeruli characterized by sudden onset of oliguria, hematuria, hypertension and edema. It is commonly caused by a streptococcal infection and results in the deposition of immune complexes in the glomeruli. On pathology, glomeruli appear enlarged and infiltrated by polymorphs with epithelial crescents. Immunofluorescence shows "lumpy-bumpy" deposits of immunoglobulin and complement. Management involves controlling hypertension and edema with diuretics, treating any underlying infection, and managing complications such as acute renal failure. The prognosis is generally good with complete recovery in most cases.
This document discusses congestive heart failure in children. It defines CHF as the heart's inability to meet metabolic demands due to reduced cardiac output or inability to dispose of venous return. Key factors affecting cardiac performance are preload, afterload, and contractility. Compensatory mechanisms in heart failure involve cardiac, systemic, and neurohormonal responses. Etiologies of pediatric CHF include congenital heart defects, cardiomyopathies, and acquired conditions. The document outlines approaches to diagnosis, treatment including medications to reduce preload and afterload, and non-pharmacological options.
Polycythemia is a condition characterized by an abnormal increase in red blood cells. It can be primary, caused by bone marrow abnormalities, or secondary, caused by factors like smoking or lung diseases that result in hypoxia. Symptoms include headache, dizziness, and skin redness or itching. Diagnosis involves blood tests showing elevated red blood cell counts. Treatment may include phlebotomy to reduce blood volume, medications to suppress blood cell production, and lifestyle changes like exercise and avoiding tobacco. Nursing care focuses on monitoring for blood clots, managing pain and nutrition, and providing education.
An increase in left-sided pressures results in dyspnea from pulmonary congestion, while an increase in right-sided pressures results in hepatomegaly and edema. Symptoms of left-sided failure include tachypnea, tachycardia, cough and wheezing, while signs of right-sided failure include hepatomegaly and facial puffiness. Management of heart failure involves reducing cardiac work, augmenting myocardial contractility, improving cardiac performance, and correcting the underlying cause.
Congestive cardiac failure diagnosis and treatmentSmilu Mohanlal
This document discusses the signs, symptoms, diagnosis, and management of congestive heart failure in pediatric patients. It notes that tachycardia is usually the first sign of CHF, except in cases involving bradyarrhythmias. As CHF worsens, signs of venous congestion emerge, affecting the lungs with left-sided failure and liver/spleen with right-sided failure. Diagnostic testing includes blood tests, ECG, chest x-ray, and echocardiogram. Treatment goals are to reduce preload and afterload, enhance contractility, and improve nutrition/oxygen delivery using diuretics, vasodilators, inotropes, and ACE inhibitors.
Neonatal jaundice is a condition in newborns marked by high levels of bilirubin in the blood, causing yellowing of the skin and whites of the eyes. Bilirubin levels are often higher in neonates due to increased red blood cell breakdown, liver immaturity, and bacterial colonization. Without treatment, hyperbilirubinemia can cause permanent brain damage known as kernicterus. Proper monitoring and treatment is important to prevent dangerous bilirubin levels in newborns.
This document provides information on respiratory distress syndrome (RDS), including its definition, etiology, pathophysiology, signs and symptoms, investigations, management, nursing diagnoses, and nursing interventions. RDS is a disease in newborns related to deficiency of surfactant in the lungs, leading to respiratory distress. Key factors that can decrease surfactant and contribute to RDS include prematurity, hypothermia, asphyxia, and having a diabetic mother. Management involves supportive care like oxygen supplementation and ventilation support if needed, as well as more aggressive treatments like surfactant replacement therapy for very preterm infants.
Please find the power point on Phototherapy in jaundice . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This document discusses iron deficiency anemia (IDA) in children. It begins by defining anemia and listing the WHO thresholds used to define anemia in different age groups. It then covers the etiological, morphological and pathophysiological classifications of anemia. Under the etiological classification, it describes anemias caused by blood loss, impaired red blood cell formation, and excessive red blood cell destruction. It also discusses the clinical features, laboratory diagnosis, treatment, complications and prevention of IDA in children.
This document discusses neonatal seizures, including their classification, causes, diagnosis, and management. It defines neonatal seizures as clinical manifestations of underlying neurological dysfunction in newborns. Seizures are classified as subtle, tonic, clonic, or myoclonic. Common causes include hypoxic-ischemic encephalopathy, intracranial hemorrhage, infections, and metabolic disturbances. Diagnosis involves a medical history, physical exam, and investigations like blood tests, imaging, EEG, and CSF examination. Initial management focuses on stabilization, treating correctable causes like hypoglycemia and hypocalcemia, and anti-seizure medications if needed. Nursing care includes emergency response, psychosocial support for family members, and
Cor pulmonale, or right heart failure, is caused by high blood pressure in the pulmonary artery and right ventricle due to conditions that restrict pulmonary blood flow such as chronic lung diseases. It develops when pulmonary hypertension leads to enlargement and failure of the right ventricle. Symptoms include shortness of breath, leg swelling, and fatigue. Diagnosis involves physical exam, imaging like echocardiogram and chest x-ray, and assessing pulmonary pressures. Treatment focuses on managing the underlying lung condition, giving diuretics and vasodilators, and may involve oxygen therapy or lung transplantation in severe cases.
Tetralogy of Fallot is a congenital heart defect combining four defects: a ventricular septal defect, pulmonary stenosis, an overriding aorta, and right ventricular hypertrophy. It is the most common cyanotic heart defect seen in 6-10% of congenital heart diseases. Affected individuals experience cyanosis and fatigue due to reduced oxygen circulation. Diagnosis involves physical exams, echocardiograms, and x-rays showing the boot-shaped heart. Treatment includes medical management of hypoxic spells as well as surgical procedures like the Blalock-Taussig shunt or complete repair to improve oxygen circulation.
This document discusses jaundice in newborns. It defines jaundice as a yellowing of the skin caused by high bilirubin levels. Jaundice is common in newborns and usually resolves on its own, but sometimes requires treatment. The document covers physiological vs pathological jaundice, clinical assessment of jaundice, risk factors, potential complications like kernicterus, treatment options like phototherapy and exchange transfusion.
This document discusses dehydration in pediatrics. It defines dehydration and explains its pathophysiology and types based on severity and fluid/electrolyte loss. Causes of dehydration include diarrhea, vomiting, excessive sweating, diabetes and burns. Diagnosis involves blood and urine tests to check electrolyte levels. Signs and symptoms range from mild thirst to severe complications depending on the percentage of fluid loss. Treatment involves oral or IV fluid replacement depending on severity. Nursing care focuses on monitoring fluid intake and output, providing skin care and educating families on prevention.
Neonatal acute respiratory distress syndrome (RDS) is caused by surfactant deficiency in premature infants. Surfactant is produced in the lungs beginning at 24 weeks gestation and helps lower surface tension to prevent alveolar collapse. Preemies are at risk for RDS due to incomplete lung development and surfactant production. Treatment includes supportive care like CPAP, surfactant replacement therapy, and mechanical ventilation if needed. With treatment and lung maturation, symptoms typically improve within 3-5 days.
Myocarditis is an inflammatory disease of the heart muscle that can be caused by infectious or non-infectious triggers. It has a variable clinical presentation ranging from mild symptoms to life-threatening conditions. The diagnosis is challenging due to the heterogeneity of symptoms but can involve electrocardiogram, cardiac biomarkers, echocardiogram, cardiac MRI and endomyocardial biopsy. About half of acute cases resolve in 2-4 weeks but some develop heart failure or arrhythmias. Treatment focuses on supporting heart function and managing symptoms while the disease runs its course.
This document outlines a presidential action plan for infectious endocarditis in children. It begins with definitions of infective endocarditis and discusses the epidemiology, pathogenesis, clinical features, diagnosis, treatment and prevention. Key points include that infective endocarditis is less common in children than adults but is increasing in those with cardiac surgery or conditions. Common causes are streptococcal and staphylococcal species. Clinical features may include fever, heart murmur and embolic phenomena. Echocardiography is important for diagnosis but blood cultures are also needed under the modified Duke criteria. Surgery may be indicated for complications such as heart failure or abscesses.
Infective endocarditis is inflammation of the heart valves caused by bacterial infection. It is often a complication of congenital or rheumatic heart disease. Common causative organisms include streptococci and staphylococci. Risk factors include prior heart disease, dental/medical procedures, and intravenous drug use. Symptoms include fever, chills, weight loss and heart murmurs. Echocardiography and blood cultures help diagnose. Treatment involves antibiotics for 4-6 weeks. Surgery may be needed for severe valve damage or persistent infection. Prognosis remains serious despite treatment, with 20-25% mortality and high morbidity rates.
Respiratory distress syndrome is a condition in premature infants caused by a lack of surfactant in the lungs. Surfactant is needed to keep the alveoli open during breathing. Without it, lungs collapse during exhalation due to surface tension. This causes respiratory failure. Risk factors include prematurity, meconium aspiration, or maternal complications. Diagnosis involves assessing breathing rate, lung sounds, oxygen needs and chest x-rays. Treatment focuses on providing oxygen, medications, and supportive care until the lungs mature enough to produce surfactant.
Cardiac arrest refers to the sudden cessation of cardiac activity and can lead to death if not treated. It is usually caused by conditions that disrupt the heart's electrical system such as coronary artery disease or structural heart abnormalities. Risk factors include a family history of sudden cardiac death, previous heart issues, and lifestyle factors like smoking and obesity. Diagnosis involves evaluating the patient's history, ECG, echocardiogram, and blood work. Treatment includes CPR, defibrillation, cardiac catheterization, bypass surgery, and medication to control arrhythmias and heart disease. Nursing care focuses on monitoring the patient's condition, providing oxygen, and educating on preventing future cardiac events.
Pediatric meningitis and encephalitis 2021Imran Iqbal
This document provides an overview of pediatric meningitis and encephalitis, including:
1. It discusses the types, epidemiology, clinical features, diagnosis, management, complications, prognosis and prevention of acute bacterial meningitis and viral meningoencephalitis.
2. Key points include the importance of vaccination, the clinical signs and symptoms of each condition, and treatments involving antibiotics, antivirals and supportive care.
3. Rare conditions like cerebral malaria, tuberculous meningitis and SSPE are also briefly covered.
Acute glomerulonephritis is an acute inflammation of the renal glomeruli characterized by sudden onset of oliguria, hematuria, hypertension and edema. It is commonly caused by a streptococcal infection and results in the deposition of immune complexes in the glomeruli. On pathology, glomeruli appear enlarged and infiltrated by polymorphs with epithelial crescents. Immunofluorescence shows "lumpy-bumpy" deposits of immunoglobulin and complement. Management involves controlling hypertension and edema with diuretics, treating any underlying infection, and managing complications such as acute renal failure. The prognosis is generally good with complete recovery in most cases.
This document discusses congestive heart failure in children. It defines CHF as the heart's inability to meet metabolic demands due to reduced cardiac output or inability to dispose of venous return. Key factors affecting cardiac performance are preload, afterload, and contractility. Compensatory mechanisms in heart failure involve cardiac, systemic, and neurohormonal responses. Etiologies of pediatric CHF include congenital heart defects, cardiomyopathies, and acquired conditions. The document outlines approaches to diagnosis, treatment including medications to reduce preload and afterload, and non-pharmacological options.
Polycythemia is a condition characterized by an abnormal increase in red blood cells. It can be primary, caused by bone marrow abnormalities, or secondary, caused by factors like smoking or lung diseases that result in hypoxia. Symptoms include headache, dizziness, and skin redness or itching. Diagnosis involves blood tests showing elevated red blood cell counts. Treatment may include phlebotomy to reduce blood volume, medications to suppress blood cell production, and lifestyle changes like exercise and avoiding tobacco. Nursing care focuses on monitoring for blood clots, managing pain and nutrition, and providing education.
An increase in left-sided pressures results in dyspnea from pulmonary congestion, while an increase in right-sided pressures results in hepatomegaly and edema. Symptoms of left-sided failure include tachypnea, tachycardia, cough and wheezing, while signs of right-sided failure include hepatomegaly and facial puffiness. Management of heart failure involves reducing cardiac work, augmenting myocardial contractility, improving cardiac performance, and correcting the underlying cause.
Congestive cardiac failure diagnosis and treatmentSmilu Mohanlal
This document discusses the signs, symptoms, diagnosis, and management of congestive heart failure in pediatric patients. It notes that tachycardia is usually the first sign of CHF, except in cases involving bradyarrhythmias. As CHF worsens, signs of venous congestion emerge, affecting the lungs with left-sided failure and liver/spleen with right-sided failure. Diagnostic testing includes blood tests, ECG, chest x-ray, and echocardiogram. Treatment goals are to reduce preload and afterload, enhance contractility, and improve nutrition/oxygen delivery using diuretics, vasodilators, inotropes, and ACE inhibitors.
Congestive heart failure is a condition where the heart cannot pump enough blood to meet the body's needs. It can be caused by issues with the heart muscle itself or from other health problems. Common symptoms include shortness of breath, fatigue, and swelling in the legs. Treatment involves medications to help the heart function better like diuretics, vasodilators, and digitalis. Nurses play an important role in managing symptoms, monitoring medication effects, providing education to patients, and assisting with diet and activity levels. Prognosis depends on the underlying cause and can range from full recovery if the cause is treated to long-term management if heart damage is more severe.
Congestive heart failure is a condition where the heart cannot pump enough blood to meet the body's needs. It can be caused by issues with the heart muscle itself or from other health problems. Common symptoms include shortness of breath, fatigue, and swelling in the legs. Treatment involves medications to help the heart function better like diuretics, and lifestyle changes like a low-sodium diet and exercise. Prognosis depends on the underlying cause and can range from full recovery if the cause is treated to long-term management if heart damage is extensive. Nurses play an important role in managing symptoms, monitoring for medication side effects, and educating patients.
CONGESTIVE HEART FAILURE.pptx slides by laila1901600146
This document defines congestive heart failure and describes its types, causes, symptoms, signs, pathophysiology, nursing care, and management. Congestive heart failure occurs when the heart cannot pump enough blood to meet the body's needs. It is classified as right-sided, left-sided, or bi-ventricular failure. Causes in infants include congenital heart defects and myocarditis. Symptoms include difficulty feeding, fast breathing, and fatigue. Management focuses on reducing cardiac workload, improving contractility with drugs, reducing preload with diuretics, and treating the underlying cause.
DRUGS ACTING ON CARDIOVASCULAR SYSTEm 1.docxEdwinMoguche1
The document provides information on drugs acting on the cardiovascular system, including their classifications, mechanisms of action, indications, and side effects. It discusses several classes of drugs in detail, including cardiac glycosides like digoxin, antianginal drugs such as nitrates and beta blockers, and calcium channel blockers. The key points are:
1) Digoxin increases contractility and decreases heart rate via indirect and direct effects on sodium-potassium ATPase pumps in cardiac cells.
2) Nitrates like nitroglycerin are used to treat angina by dilating blood vessels and reducing oxygen demand, while beta blockers lower heart rate and contractility.
3) Calcium channel blockers
Congestive cardiac failure (CHF) refers to systemic and pulmonary congestion resulting from the heart's inability to pump enough blood for the body's needs. It has multiple causes in infants and children, including structural heart defects, arrhythmias, infections, and cardiomyopathies. Presentation depends on the degree of cardiac reserve but includes symptoms like tachypnea, tachycardia, poor feeding, and hepatomegaly. Diagnosis involves history, physical exam, chest x-ray, ECG, echocardiogram and other tests. Treatment focuses on correcting underlying causes, managing precipitants, and controlling heart failure through diuretics, inotropic drugs, afterload reducers, and other
Advanced stage heart failure can result from any structural or functional issues that reduce the heart's ability to pump blood effectively. Common causes include coronary artery disease, heart attacks, and uncontrolled hypertension. Symptoms vary by individual but can include shortness of breath, fatigue, swelling, and confusion. Diagnosis involves tests like echocardiograms to check the ejection fraction of the left ventricle and blood tests to examine biomarkers like BNP and CRP levels. Treatment is multifaceted, focusing on lifestyle changes, medications, and possibly surgery, with the goals of managing symptoms and improving quality of life.
This document provides information on the approach and assessment of acyanotic congenital heart diseases in children. It discusses:
1. The typical presenting complaints which include feeding difficulties, respiratory distress, easy fatigability, recurrent infections, and failure to thrive.
2. The physical exam findings to assess including inspection, palpation of pulses, blood pressure, jugular venous pressure, auscultation of heart sounds and murmurs.
3. The classification of acyanotic heart diseases which include left-to-right shunts and outflow obstructions. The most common types are also listed.
Congestive heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It can be caused by conditions present at birth like hypoplastic left heart syndrome. Symptoms include poor weight gain, fast breathing, and edema. Diagnosis involves chest x-ray, electrocardiogram, echocardiogram, and sometimes cardiac catheterization. Treatment focuses on underlying causes, medications to control symptoms like diuretics and digoxin, and surgery when possible to correct structural heart defects.
This document discusses cardiomyopathy in neonates and children. It covers the classification, epidemiology, causes, pathophysiology, clinical presentation, diagnostic evaluation, and management of various types of cardiomyopathy including dilated, hypertrophic, restrictive, and ischemic cardiomyopathy. The key points are:
1. Cardiomyopathy can present as recurrent wheezing in children and has an incidence of 1 in 100,000 with higher rates in infancy. Common causes include viral myocarditis, genetic factors, and metabolic disorders.
2. Diagnostic evaluation involves ECG, echocardiogram, blood tests, and cardiac catheterization. Echocardiogram can identify features like ventricular dilation or hypertrophy
Care of the child with a physical disorder08bholmes
Congenital heart disease affects 5-10% of newborns. Common types include patent ductus arteriosus, atrial septal defects, and ventricular septal defects. Signs include cyanosis, murmurs, and heart failure. Diagnostic tests include EKGs, echocardiograms, and cardiac catheterization. Treatment ranges from medications to close defects to open heart surgery to repair defects. Common blood disorders in children include iron deficiency anemia, sickle cell anemia, and hemophilia.
This document discusses congestive cardiac failure (CHF) in infants and children. It defines CHF and lists various causes that can lead to CHF depending on the age of onset, including structural heart defects, metabolic abnormalities, and acquired heart conditions. The pathophysiology, symptoms, signs, investigations, and treatment approaches for CHF are described. Treatment involves addressing underlying causes, precipitating factors, and controlling the heart failure state using diuretics, inotropic agents, afterload-reducing drugs, and other medications like digoxin.
Congenital heart defects are abnormalities in the heart's structure that are present at birth. They range from simple defects with no symptoms to complex defects that are life-threatening. They affect about 8 in 1,000 newborns. Some defects require immediate medical care, while others need no treatment or can be easily fixed. Common types include atrial septal defects, ventricular septal defects, tetralogy of Fallot, coarctation of the aorta, and patent ductus arteriosus. Treatment options depend on the size and severity of the defect, and may include medications, cardiac catheterization, or open-heart surgery.
Dr. Eke Eghosasere Paul gave a presentation on pediatric heart failure to the Nelson Club on September 15, 2014. The presentation covered the epidemiology, etiology, pathophysiology, clinical signs and symptoms, diagnosis, treatment and prognosis of heart failure in children. Heart failure occurs when the heart cannot meet the body's metabolic needs due to reduced cardiac output. Compensatory mechanisms initially help maintain function but eventually become ineffective, leading to worsening clinical symptoms. Proper diagnosis and management of the underlying cause are important for treatment.
Thyroid hormones play a critical role in development and metabolism. The thyroid produces T4 and T3, with T3 having greater biological activity. Iodine is required for thyroid hormone production. Hyperthyroidism can cause many cardiovascular effects like palpitations, atrial fibrillation, hypertension and heart failure due to increased heart rate and cardiac output. Treatment involves beta-blockers, antithyroid drugs, radioiodine and restoring euthyroidism.
1. Acyanotic heart defects are congenital heart disorders involving left to right shunting of blood without cyanosis. Common defects include atrial septal defects (ASD) and ventricular septal defects (VSD).
2. ASDs involve an abnormal opening between the left and right atria, increasing pulmonary blood flow. VSDs involve an opening between the left and right ventricles, also increasing pulmonary flow.
3. Clinical manifestations vary depending on defect size but may include fatigue, palpitations, infections. Diagnosis involves echocardiogram, EKG, chest x-ray. Surgical repair is often recommended.
The document discusses pregnancy-induced hypertension (PIH), including risk factors, symptoms, medical and nursing management, and interventions. PIH is a condition characterized by vasospasm and hypertension during pregnancy. Primary treatment goals are delivery of the fetus, reducing vasospasm and preventing seizures. Nursing focuses on monitoring the patient, administering medications to control blood pressure and prevent eclampsia, and delivering the baby via induction or c-section if needed to stabilize the mother's condition.
This document discusses avoiding heart attacks and strokes by protecting oneself. It describes several heart conditions including heart failure, which occurs when the heart cannot pump enough blood due to damage from prior heart attacks or other causes. Congenital heart disease refers to defects present at birth, while rheumatic heart disease results from untreated strep throat and damages heart valves over time. Preventing rheumatic fever through prompt antibiotic treatment of strep throat is the best way to avoid rheumatic heart disease.
This document discusses clinical manifestations and evaluation of renal disease in children. Common signs of renal disorders include edema, hematuria, abnormalities in urination, and flank or abdominal pain. Evaluation of renal disease involves examination of urine for red blood cells, proteins, and casts. Imaging tests like ultrasound and IVU can identify structural abnormalities. Glomerular diseases commonly cause hematuria while tubular disorders present with electrolyte abnormalities. Renal biopsy may be needed to diagnose conditions like Alport syndrome.
This document summarizes common viral infections including measles, varicella, mumps, and viral hepatitis. Measles is caused by a paramyxovirus and causes a rash and respiratory symptoms. Varicella (chickenpox) is caused by varicella zoster virus and presents with a pruritic vesicular rash that spreads. Mumps is caused by a paramyxovirus and presents with painful swelling of the salivary glands. Hepatitis A and B viruses are described as common causes of viral hepatitis transmitted through fecal-oral and blood-borne routes respectively.
Principles of acute management of diabetic ketoacidosisEric General
This document provides guidelines for managing diabetic ketoacidosis (DKA) in children. It outlines recommendations for initial fluid bolus and hydration, monitoring of electrolytes and glucose during treatment, use of bicarbonate and insulin therapy, and monitoring of vital signs and lab values. It also describes cerebral edema as a potential complication of DKA and recommends reducing fluid administration rates and using mannitol or hypertonic saline if cerebral edema develops.
This document discusses pediatric anemia. It defines anemia based on hemoglobin and hematocrit levels below certain thresholds defined by age and sex. Anemia results in physiological adaptations like increased cardiac output to maintain oxygen delivery to tissues. Causes of anemia vary by age and can be multifactorial, including nutritional deficiencies, blood loss, infections, and genetic disorders. Iron deficiency is a common cause, presenting with microcytic indices and low iron studies. Evaluation involves a complete blood count and smear to classify anemia, along with testing to identify the underlying cause.
Congenital heart disease (CHD) refers to structural heart defects present at birth. Diagnosis involves history, physical exam, chest X-ray, ECG, and echocardiogram. Most CHDs can be corrected with surgery if done in a timely manner. Echocardiography can identify and determine severity of specific lesions. Pediatricians must also identify any associated conditions that could impact outcomes.
1. Tracheoesophageal fistula occurs due to deviation or altered cellular growth in the septum that separates the respiratory and esophageal primordia during development. It has an incidence of 1 in 4,000 live births.
2. Clinical features include excessive drooling, choking, and cyanosis during feeding as well as aspiration pneumonia from overflow of secretions into the lungs.
3. Diagnosis is made by passing a stiff catheter into the esophagus and obtaining an x-ray, which will show an air bubble in the stomach if there is a communication between the esophagus and trachea.
The document summarizes information about malaria, including that it is caused by Plasmodium parasites and can range from uncomplicated to severe. Severe malaria affects multiple organ systems and has a 20% mortality rate if not properly treated. Diagnosis involves examining thick and thin blood films under a microscope. Treatment depends on the severity of the case, with uncomplicated malaria typically treated with artemisinin-based combination therapy and severe malaria requiring hospitalization and parenteral antimalarial drugs along with supportive therapies.
This document provides information on various types of acyanotic congenital heart defects, including their anatomy, physiology, clinical features, diagnosis, treatment and prognosis. It discusses atrial septal defects (ASD), ventricular septal defects (VSD), and patent ductus arteriosus (PDA). ASDs are classified based on their location. VSDs account for one-quarter of all congenital heart defects and result in left-to-right shunting. PDA causes left-to-right shunting between the aorta and pulmonary artery. Surgical or catheterization closure is often recommended for larger defects.
Neonatal sepsis refers to systemic bacterial infections in newborns. Early-onset sepsis occurs within 72 hours of birth and is usually caused by maternal genital tract organisms. Late-onset sepsis occurs after 72 hours and is often caused by environmental organisms acquired in the hospital or home. Treatment involves supportive care and empiric antibiotics targeting common causes like E. coli, S. aureus, and Klebsiella spp. Prompt treatment is important but overuse of antibiotics risks emerging resistance, so diagnosis is confirmed using blood cultures and sepsis screening tests when possible. Outcomes depend on the infant's health and prompt, appropriate treatment.
This document provides guidance on performing a newborn history and examination. It outlines key components to include in the history such as the mother's obstetric history, antenatal care, labor/delivery details, and newborn's immediate care and current problems. The examination section describes assessing the newborn's appearance, vital signs, measurements, and performing a full physical exam including the neurological exam and evaluating primary reflexes like the Moro reflex. The goal is to obtain a thorough history and perform an examination of all body systems to identify any issues in the newborn.
Respiratory distress in neonates can be caused by pulmonary issues like respiratory distress syndrome, pneumonia, or transient tachypnea of the newborn, or non-pulmonary issues like cardiac problems, hypoglycemia, or central nervous system conditions. Early recognition and prompt treatment is essential to improve outcomes. Respiratory distress is characterized by tachypnea, chest retractions, and/or grunting. Causes and management should be considered based on gestational age, time of onset, and associated clinical features.
This document discusses acute kidney injury (AKI), formerly known as acute renal failure, in pediatrics. It defines AKI, describes the causes and pathophysiology, presents approaches to evaluation and management, and outlines treatment of complications. The key points are:
- AKI is defined as an abrupt reduction in kidney function over 48 hours, seen as a rise in creatinine or decrease in urine output.
- Common causes include prerenal failure from hypovolemia, intrinsic renal failure like acute tubular necrosis, and postrenal failure from urinary tract obstruction.
- Management involves treating complications, maintaining fluid/electrolyte balance, and considering dialysis for issues like fluid
This document discusses jaundice in newborns. It describes physiological jaundice as normal and temporary, while pathological jaundice requires treatment. Pathological jaundice is defined as a total serum bilirubin level exceeding certain thresholds depending on the baby's age. Causes of jaundice include hemolytic issues and problems with feeding. Treatment may involve phototherapy or exchange transfusions in severe cases. Monitoring, prevention, and ensuring proper breastfeeding are also discussed.
This document discusses acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). It describes the epidemiology, pathogenesis, classification, clinical presentation, diagnosis, prognostic factors, management and outcomes of both ALL and AML in children. ALL is more common and has a better prognosis than AML. Prognostic factors for ALL include age, white blood cell count, specific genetic mutations and response to initial treatment. Treatment involves induction, consolidation, central nervous system prophylaxis and maintenance therapy over 2-3 years.
This document discusses encephalitis and encephalopathies in pediatrics. Encephalitis involves inflammation of the brain parenchyma, while encephalopathy implies cerebral dysfunction due to toxins or metabolic disorders without inflammation. Etiologies include various viruses, bacteria, fungi, parasites, toxins and metabolic disorders. Clinical manifestations depend on severity, localization, and presence of increased intracranial pressure, and can range from mild illness to severe encephalomyelitis. Diagnosis involves ruling out treatable causes through examinations, tests, and imaging. Management focuses on emergency treatment, controlling seizures and pressure, and treating the underlying cause.
This document discusses cerebral palsy (CP), a nonprogressive neuromotor disorder of cerebral origin. CP can be caused by factors operating prenatally, during delivery, or postnatally. It is classified based on topographic distribution, neurological findings, and etiology, with the main types being spastic, hypotonic, extrapyramidal, and cerebellar CP. Evaluation of patients with CP includes assessing eyes, ears, speech, sensory function, seizures, intelligence, and other issues. The diagnosis is made based on signs of increased muscle tone, feeding difficulties, and developmental delays. Differential diagnoses need to be considered. Management aims to improve posture, reduce muscle tone, prevent contractures, and provide early
Perinatal asphyxia is caused by lack of oxygen or poor perfusion to organs in fetuses or newborns. It is defined by criteria like low umbilical cord pH, low Apgar scores, seizures or multiorgan dysfunction in newborns. It can cause neurological injuries like selective neuronal necrosis or periventricular leukomalacia. Management involves maintaining normal temperature, oxygenation, blood pressure, blood glucose and treating seizures. Outcomes are predicted by factors like lack of breathing at birth or severe hypoxic ischemic encephalopathy.
This document summarizes HIV infection in pediatric patients. It describes the natural history of the disease, including three patterns of progression. It discusses clinical manifestations, opportunistic infections like Pneumocystis pneumonia, and respiratory diseases seen in HIV-infected children. It also outlines the WHO clinical staging criteria for pediatric HIV/AIDS.
This document provides information on acute bacterial meningitis in pediatrics, including epidemiology, clinical features, diagnosis, treatment and other types of meningitis such as tuberculous, cryptococcal and pneumococcal meningitis. It describes the typical presentation of acute bacterial meningitis in children including fever, irritability, headache and altered mental status. Diagnosis is made through lumbar puncture and examination of cerebrospinal fluid. Treatment involves administration of antibiotics such as ceftriaxone intravenously for 10-14 days. Complications, steroid use, and other types of meningitis are also summarized.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
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In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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2. Congestive cardiac failure is the inability of the
heart to
maintain an output, at rest or during stress,
necessary
for the metabolic needs of the body (systolic
failure) and
inability to receive blood into the ventricular
cavities at
low pressure during diastole (diastolic failure).
3. An increase in left sided pressures results in
dyspnea from
pulmonary congestion. An increase in right
sided
pressures results in hepatomegaly and edema.
4. Rheumatic fever
and rheumatic heart disease is typically encountered
beyond 5 yr age; its prevalence appears to be declining
in
selected urban populations. Heart failure from
congenital heart disease typically
happens within the first 1-2 yr of life. Patients with left
to
right shunts tend to develop CCF around six to eight
weeks of life. Heart failure from congenital heart
disease typically
happens within the first 1-2 yr of life. Patients with left
to
right shunts tend to develop CCF around six to eight
weeks of life.
5. Arrhythmias are an important cause of
congestive
cardiac failure in infancy. Three-quarters of
infants with
paroxysmal supraventricular tachycardia are
below
4 months old. Heart rates above 180/min tend
to precipitate
heart failure. If the tachycardia persists for 36
hr, about 20% will
develop heart failure and almost 50% will do so
in 48 hr.
6. Infants
Congenital heart disease
Myocarditis and primary myocardial disease
Tachyarhythmias, bradyarhythmias
Kawasaki disease with coronary occlusion
Pulmonary hypertension (persistent
pulmonary hypertension
of the newborn; primary pulmonary
hypertension; hypoxia,
e.g. upper airway obstruction)
9. The recognition of cardiac failure in older children is
based
on the same features as in adults.
Symptoms. Slow weight gain is related to two factors.
The
infant takes small feeds because of easy fatigability
and
there is an excessive loss of calories from increased
work
of breathing. Uncommonly, there may be an unusual
gain
in weight due to collection of water, manifesting as
facial
puffiness or rarely as edema on the feet.
10. Often a mother may state that
the baby breathes too fast while feeding or
that the baby
is more comfortable and breathes better when
held against
the shoulder-which is the equivalent of
orthopnea in
older children. Not infrequently, the baby is
brought with
persistent hoarse crying, wheezing, excessive
perspiration
and less commonly, because of facial puffiness
11. Signs. Left sided failure is indicated by
tachypnea and
tachycardia. Persistent cough, especially on
lying down,
hoarse cry and wheezing are other evidences
of left sided
failure; basal rales in the chest are usually not
audible.
12. Right-sided failure is indicated by hepatomegaly and
facial
puffiness. Examination of the neck veins in small babies
is not helpful. Firstly, it is difficult to evaluate the short
neck with baby fat and secondly, hemodynamic studies
show that right atrial mean pressures stays normal in
more
than one-half of infants with congestive failure. Edema
on the feet occurs late. Common to both left and right
sided
failure is the presence of cardiac enlargement, third
sound
gallop and poor peripheral pulses with or without
cyanosis
13. Left sided failure
Tachypnea
Tachycardia
Cough
Wheezing
Rales in chest
Right-sided failure
Hepatomegaly
Facial edema
Jugular venous
engorgement
Pedal edema
Failure of either side
Cardiac enlargement
Gallop rhythm (S3)
Peripheral cyanosis
Small volume pulse
Lack of weight gain
14. Management of heart failure is a four-pronged
approach
for correction of inadequate cardiac output. The
fourprongs
are: (i) reducing cardiac work, (ii) augmenting
myocardial contractility, (iii) improving cardiac
performance,
(iv) correcting the underlying cause
Identification
of the cause is important since it has direct
bearing on survival.
15. The work of the heart is reduced by restricting
patient
activities, sedatives, treatment of fever,
anemia, obesity, and by
vasodilators. Mechanical ventilation helps
when heart failure
is severe by eliminating the work of breathing.
16. Neonates with heart failure are nursed in an incubator.
They are handled minimally. The baby is kept propped
up at an incline of about 30
°
. The pooling of edema fluid
in the dependent areas reduces the collection of fluid
in
lungs, thus reducing the work of breathing. At a
temperature of 36-37
°
C, the overall circulatory and
metabolic needs are minimal, thus reducing work of
heart.
17. If the infant or the child is restless or dyspneic,
sedatives
are used. Morphine sulfate in doses of 0.05 mg/kg
SC
provides effective sedation. A benzodiazepine such
as
midazolam is useful for sedation in selected
circumstances.
Sedatives reduce anxiety and lower the
catecholamine
secretion, thus reducing physical activity,
respiratory and
heart rate. Requirement of oxygen for body tissues
goes
down, and this reduces the cardiac workload.
18. Fever, anemia or infection also increase the
work of the
heart. In infants and smaller children the
presence of
superadded pulmonary infection is difficult to
recognize.
Antibiotics are therefore, sometimes
administered
empirically. In older children antibiotics are
used, only if
evidence of infection is present
19. Anemia imposes stress on the heart because of the
decreased oxygen carrying capacity of blood. Anemia
results in tachycardia and in a hyperkinetic circulatory
state. Correction of anemia will result in decreased
cardiac
work. If transfusion is indicated packed red cells can be
administered. Typically packed cell volumes of 10-20
ml/
kg are required to correct severe anemia; a single dose
of
frusemide IV is often given prior to the transfusion. Less
common conditions causing stress to the heart are
repeated
pulmonary emboli, thyrotoxicosis and obesity.
20. Vasodilators counteract the compensatory
mechanisms in
heart failure and improve cardiac
outputArteriolar and venous vasoconstriction
is mediated through
catecholamines. Arteriolar constriction
maintains blood
pressure by increasing the systemic vascular
resistance,
which increases the work of heart. Nitrates are
used as preferential venodilators and
hydralazine as an arteriolar
dilator.
21. ACE inhibitors (captopril, enalapril) are effective for
treating heart failure in infants and children. These
agents
are effective vasodilators, suppress renin-
angiotensinaldosterone
system, reducing vasoconstriction and salt
and water retention. By suppressing catecholamines,
they
prevent arrhythmias and other adverse effects on the
myocardium. The major side effect of ACE inhibitors is
cough, which can be troublesome. Persistent cough may
necessitate the use of angiotensin receptor blockers,
such
as losartan.
22. Initially it is necessary to monitor the renal
function: urinalysis, blood levels of creatinine
and electrolytes
once a week for six to eight weeks. These
medications
may cause first-dose hypotension; the first
dose should
be one-quarter of the calculated dose. The
patient should
ideally remain recumbent for the first 6 hr to
prevent an
unusual fall in blood pressure.
23. Although beta-blockers might precipitate CCF, they
improve symptoms and survival especially in patients
with dilated cardiomyopathy, who continue to have
tachycardia.
Useful agents include metoprolol and carvedilol.
The latter is preferred since it has properties of
betablockers
with peripheral vasodilation; treatment is started
at low dose and increased depending on tolerability
(0.08
to 0.4 mg/kg/day, maximum 1.0 mg/kg/day). Calcium
channel blockers have adverse effects in heart failure
and
should be avoided unless indicated for systemic
hypertension.
24. In the acute care setting, sodium nitroprusside is
used as
a vasodilator, since it acts on the venous and
arterial systems. These
agents have powerful vasodilatory and inotropic
effects.
Specific indications for use of vasodilators include
acute
mitral or aortic regurgitation, ventricular
dysfunction
resulting from myocarditis, anomalous coronary
artery from
pulmonary artery and in the early post operative
setting.
25. Augmenting myocardial contractility by inotropic agents
like digitalis improves cardiac output. In infants and
children, only digoxin is used. It has a rapid onset of action
and is eliminated quickly. It is available for oral and
parenteral administration. Oral digoxin is available as 0.25
mg tablets and as digoxin elixir (1 ml = 0.05 mg) (Table
15.6). Parenteral digoxin (0.5 mg/2 ml) is available; its dose
is 70% of the oral dose. Infants tolerate digitalis well. In a
hospitalized patient
full digitalization should be sought to maximize benefit.
Children are digitalized within a 24 hr period; 1h of the
calculated digitalizing dose is given initially, followed by
% in 6-8 hr and the final % after another 6-8 hr. The
maintenance dose is usually one-quarter of the digitalizing
dose
26. Before the third daily dose, an
electrocardiogram is done to rule out digitalis toxicity.
Toxicity can be controlled by omitting the next one or two
doses. Digitalis is used with caution in the following
situations:
(i) premature neonates; (ii) heart failure due to myocarditis;
and (iii) very cyanotic patients. In other situations, it is
better to use half the calculated digitalizing and the
maintenance
dose initially. Myocardial damage, gross cardiomegaly,
hypoxia, acidosis, hepatic, renal and pulmonary
insufficiency increase the sensitivity of the myocardium to
digitalis. Digoxin is beneficial for symptom relief and is
advised in patients with mild, moderately severe or severe
congestive failure, with or without sinus rhythm. Digoxin
can be combined with ACE inhibitors for synergistic effect.
By increasing cardiac output, digoxin lowers systemic
impedance indirectly, unloading the ventricles
27. These agents belong to two groups: (i) catecholamine
inotropes, like dopamine, dobutamine and adrenaline and
(ii) phosphodiesterase inhibitors like amrinone and
milrinone. These agents combine inotropic effects with
peripheral vasodilation. If blood pressure is low, dopamine should be
used, as an intravenous infusion. At a dose
of less than 5 microgram/kg per minute, dopamine causes
peripheral vasodilation and increases myocardial
contractility. Renal blood flow improves, resulting in
natriuresis; higher doses result in peripheral vasoconstriction.
The dose of dobutamine is 2.5 to 15 microgram/
kg/ min; the dose should be increased gradually
until the desired response is achieved. In patients with
dilated cardiomyopathy, dobutamine is used as 24 hr
infusion once or twice a week and retains its effectiveness
for varying lengths of time.
28. Diuretics reduce the blood volume, decrease venous
return and ventricular filling. This tends to reduce the
heart size. The larger the heart, the more the wall
tension
and the poorer is its performance. With reduction in
heart
size and volume, the myocardial function and the
cardiac
output improve. Diuretics reduce the total body sodium
thereby, reducing blood pressure and peripheral
vascular
resistance. This helps in increasing the cardiac output
and
reducing the work of the heart.
29. Diuretics are the first line of management in congestive
failure. The action of oral frusemide starts within 20
min.
Frusemide should be used in combination with a
potassium sparing diuretic (triamterene,
spironolactone,
amiloride) instead of using potassium supplements. The
combination prevent potassium and magnesium loss and
reduces the risk of arrhythmias. Frusemide activates
the
renin angiotensin aldosterone axis, which is responsible
for vasoconstriction and sodium and water retention.
When frusemide is combined with ACE inhibitors, the
combination suppresses the axis and is therefore
synergistic.
30. The other method of altering the body fluid volume is
by restricting the sodium intake. Sodium restriction is
difficult to implement in infants and young children.
Low
sodium diets should be used only if the heart failure
cannot
be controlled with digitalis, diuretics and ACE
inhibitors.
However, it is prudent to advise such patients to avoid
salt rich foods such as chips and pickles. Since heart
failure
increases calorie requirements, adequate intakes is
advised.
31. Digitalizing
dose, mg/kg
Maintenance
(fraction of
digitalizing dose)
Digoxin
Premature, neonates
1 month to one year
1 to 3 yr
Above 3 yr
0.04
0.08
0.06
0.04
1/4
1/3to1/4
1/3to1/4
1/3
Diuretics
Frusemide
Spironolactone
1-3 mg/kg per day
orally or
1 mg/kg per dose IV
1 mg/kg orally every 12
hr