presentation regarding investigations and treatment of heart failure in pediatrics, including the management of an emergency , and includes brief description about even drugs used
presentation regarding investigations and treatment of heart failure in pediatrics, including the management of an emergency , and includes brief description about even drugs used
Definition, classification, epidemiology, etiology, diagnosis, prognosis of DCM, HOCM, LVNC
Also review of acute myocarditis in children
R/v of heart failure management
This power point is prepared from text books, guidelines and literature. so it will be up date based on the need and not used for management of patients.
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R/v of heart failure management
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5. DEFINITION
Heart Failure occurs when the heart is
unable to deliver adequate cardiac output to meet
the metabolic needs of the body.
Nelson Textbook of Pediatrics, 19th Edition.
6. EPIDEMIOLOGY
Congenital
VSD
ASD
Aortic Stenosis
PDA
Coarctation of the Aorta
Cardiac Muscle
Related
Rheumatic Heart
Disease
Endocarditis
Myocarditis
Others
Arrythmia
Thyrotoxicosis
Anemia
Toxic drugs
Most common case of Heart Failure in Malaysia:
(from Malaysian Pediatrics Association)
12. AFTERLOAD VS PREALOAD PATHOLOGY
Afterload
Obstruction
High Lt ventricle systolic
pressure
Increase contractility sue to
pressure overload.
Prolongation cause diminish
cardiac contractility
HF
14. ABNORMAL LOADING CONDITIONS
Preload
(Volume overload)
VSD
PDA
Valvular Insufficiency
*Most common cause in
children.
Afterload
(Pressure overload)
• Aortic Stenosis
• Pulmonary
Stenosis
• Coarctation of the
Aorta
15. Contractility :
Normal : Frank-Starling Law – is the ability of the heart to change force
of contraction dependent on the change of preload.
HF: Myocardium abnormalities either congenital or acquired. (Intrinsic
contractility compromised). Eg: myocarditis, cardiomyopathy, muscular
dystrophy.
Heart Rate :
Eg: Tachyarrythmias shortens the diastolic time interval for ventricular
filling. Also affect the time for coronary perfusion.
16. LEFT, RIGHT AND BIVENTRICULAR HEART
FAILURE
1. Left-sided heart failure.
Reduce left ventricular output. High pressure in left atrial,
pulmonary vein. Pulmonary congestion.
2. Right-sided heart failure.
Reduce right ventricular output, for any given right atrium
pressure. Eg. Chronic lung disease.
3. Biventricular heart failure.
Secondary to the progression of the disease. Eg. Dilated
cardiomyopathy, ischemic heart disease.
17. Heart fails to keep pace with the hemodynamic demands.
Decrease myocardial performance. Myocardium metabolic
demand unmet.
Compensatory mechanism take place.
Initially compensated, at the end become decompensated.
Functional and structural disturbance of the heart
21. Sign and Symptoms in Infancy
Symptoms
Feeding difficulty : poor suck, prolonged time to feed, sweating during
feeding
Recurrent chest infections
Failure to thrive
Sign
Resting tachypnoea, subcostal recession
Tachycardia, poor peripheral pulses, poor peripheral perfusion
Hyperactive praecordium, praecordial bulge
Hepatomegaly
Wheezing
22. In children, the sign and symptoms may be similar
with adults.
• Fatigue
• Effort intolerance
• Anorexia
• Abdominal pain
• Dyspnea
• Orthopnea
• Cough
• Edema (dependent part of body)
• Cardiomegaly
• JVP raised
23. Common sign of heart failure in adults eg.
Increase jugular venous pressure,
Leg edema,
Basal crackles
Are NOT usually found in chlidren.
24. INVESTIGATION
Chest X-ray
-cardiomegaly
-pulmonary edema
ECG
-chamber hypertrophy
-assess the cause of HF (Not diagnosis)
-evaluate rhythm disorder
- QRS morphologic n ST-T wave abnormalities =
myocardial inflammatory ds n pericardiatis
28. TREATMENT
Aim
Enhancing cardiac contractility
Reducing the preload & afterload
Improving oxygen delivery
General
O2 supplement, in a propped up position
Strict bed rest rarely necessary
Keep warm n gentle handling
Fluid restriction (3/4 normal) only if not dehydrated or in shock
Correct the anemia, electrolyte imbalance, treat concomitant
chest infection
30. Captopril
•ACE inhibitor
•Afterload reducing agent
Digoxin
Useful in:
excessive tachycardia
supraventricular
tachyarrhythmias
IV Inotropic agents
•Use for high force contraction
• Acute HF
•Cardiogenic shock
•Post low output syndrome
31. SPECIFIC MANAGEMENT
Etiology establishment
Specific treatment for targeted etiology
Congenital - Surgical or transcatheter treatment
Heart block - Pacemaker
Post infectious glomerulonephritis - Control BP
Acute rheumatic carditis - High dose aspirin
33. REFERENCES
Nelson Textbook of Paediatrics, 19th edition.
Nelson Essentials of Paediatrics, 7th edition.
Paediatric Protocols for Malaysian Hospitals, 3rd
edition.
Davidson’s Principles and Practice of Medicine, 21st
edition.
Editor's Notes
QRS morphologic n ST-T wave abnormalities = myocardial inflammatory ds n pericardiatis