Cardiac Failure in a Child Flashcards
Define cardiac failure in a child
Results when the heart can no longer meet the metabolic demands of the body.
Congestive heart failure (CHF): Refers to increased venous congestion in the pulmonary (left heart failure) or systemic (right heart failure) veins. This occurs when the compensatory mechanisms used to improve cardiac output are no longer adequate, and heart failure becomes uncompensated.
What are the overarching theories surrounding cardiac failure in a child?
Over-circulation
Pump failure
Explain the aetiology/risk factors surrounding cardiac failure to do with over-circulation.
Normal forward blood flow is disrupted, and the heart becomes an inefficient pump.
Congenital heart disease (CHD): Hypoplastic left heart (HLH), severe aortic stenosis, interrupted aortic arch, coarctation of the aorta (COA), patent ductus arteriosus (PDA), total anomalous pulmonary venous drainage (TAPVD), large VSD, transposition of the great arteries (TGA), truncus arteriosus.
Postoperative repair of CHD.
Arteriovenous malformation, e.g. hepatic.
Severe anaemia, e.g. hydrops fetalis.
Explain the aetiology/risk factors surrounding cardiac failure to do with pump failure.
Heart muscle is damaged and no longer contracts normally.
Viral myocarditis/cardiomyopathy
Metabolic cardiomyopathy (e.g. Pompe disease)
Arrhythmias: SVT, VT or congenital heart block (CHB)
Ischaemia (post-Kawasaki disease)
Duchenne muscular dystrophy
Medications e.g. chemotherapy
What are congenital risk factors for cardiac failure?
Down’s
Turner’s
Marfan
Noonan syndromes
Summarise the epidemiology of cardiac failure in children.
Rare in children; more common in infants with CHD.
What are the symptoms of cardiac failure in children?
Infants: Breathlessness, wheeze (cardiac asthma), grunting, feeding difficulties, sweating, failure to thrive, recurrent chest infections.
Older children: Fatigue, exercise intolerance, dizziness or syncope.
What are the signs of cardiac failure in children?
General: Tachycardia (not in CHB); absence of a heart murmur does not exclude heart disease (TGA, HLH, COA).
Left CHF: Tachypnoea, respiratory distress (recession), gallop rhythm, displaced apex.
Right CHF: Hepatosplenomegaly > oedema or ascites. Jugular venous distension is not a reliable indicator in infants and young children.
Uncompensated CHF: Hypotension, cool peripheries, prolonged capillary refill time, thready pulse, decreased urine output, signs of renal and hepatic failure in severe cases.
What are investigations for cardiac failure in children?
Bloods: Acid/base balance, electrolytes and osmolality (likely SIADH), liver and renal function.
CXR: Cardiomegaly, increased pulmonary vascular markings and fluid collection in the horizontal fissure/pleural effusions may be detected.
ECG: Rate, rhythm, atrial/ventricular hypertrophy or hypoplasia. Evidence of myocarditis/ cardiac ischemia or ventricular strain.
ECHO: Diagnostic for CHD.
Cardiaccatheterisation: Measures intracardiac pressures and shunts.
What is the management for cardiac failure in children?
Newborn/infant: Duct-dependent CHD is the most likely cause for heart failure so IV prostaglandins should be commenced immediately.
Goals of medical therapy: Reducing the preload (loop and thiazide diuretics), enhancing cardiac contractility (inotropes), reducing the afterload (ACE inhibitors), improving oxygen delivery, and enhancing nutrition.
Surgical: Cardiac transplantation.
What are complications associated with cardiac failure in children?
Arrhythmias
SVT
VT
CHB
Cardiogenic shock
What is the prognosis of cardiac failure in children?
Poor in children in the absence of correctable CHD.
