Paeds: Congestive Cardiac Failure Flashcards Preview

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Flashcards in Paeds: Congestive Cardiac Failure Deck (12):
1

Causes in neonates

Neonates

2

Causes in infants

- VSD
- AVSD
Large PDA

3

other causes of CCF

- Cardiomyopathy
- Myocarditits: viral, rheumatic fever
- Endocarditits
- Myocardial ischaemia: Kawasaki disease
- Tachyarrhythmia:SVT
- Acute hypertension
High-output: severe anaemia, thyrotoxicosis; AV malformations

4

HF in neonate is due to

L heart obstruction (co-arctation of the aorta)
IF it is very severe then arterial perfusion may be mostly R-L via the arterial duct “duct dependent”.
So closure of the duct rapidly causes death

5

HF in infants is due to

L to R shunts
Symptoms of HF will last up to 3 months and may then improve as the resistance for the r sie increases to compensate for the L-R shunt.
If left untreated then Eisenmengers syndrome occurs

6

Eisenmengers

Irreversibly increased pulmonary vascular resistance due to chronically raised pulmonary pressure and flow.

7

Symptoms of Poor tissue perfusion

- Fatigue
- Poor exercise tolerance
- Confusion
- Sweating
Poor feeding and failure to thrive

8

Congestion of circulation

- Dyspnoea
- Pleural effusion
- Pulmonary oedema
- Hepatomegaly
- Peripheral oedema
Tachycardia/”gallop” rhythm

9

Pathophysiology

- Increased afterload (pressure work)
- Increased preload (volume work)
- Myocardial abnormalities
- Tachyarrhythmias

10

Signs:

1. Increased resp rate and heart rate
2. Hear murmur – gallop rhythm
3. Enlarged heart
4. Hepatomegaly
5. Cool peripheries

11

Investigations:

- CXR cardiac enlargement, Lung - oligaemic, oedema
- Echocardiopraphy: congenital heart defects
- Arterial blood gas: reduced PO2/metabolic acidosis
- ECG: not diagnostic but may assist
- Serum electrolytes: hyponatraemia due to water retention

12

Mx

1. Bed rest and nurse in semi-upright position: infants in chair/seat
2. Supplemental oxygen (not in left to right shunt)
3. Diet: Sufficient calorie intake
4. Diuretics
5. Angiotensin converting enzyme inhibitors

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