2 - Paeds - CVS - Cardiac Failure Flashcards
Presentation - sx?
sob
sweating
poor feeding
recurrent chest infections
signs?
poor weight gain tachypnoea tachycardia murmur/gallop rhythm cardio/hepatomegaly cold peripheries
signs of RHF in particular?
when are these likely to be seen?
peripheral oedema, ascites
rare
but - seen with chronic rheum fever/pulm HTN with Tri Regurg and R atrial dilatation
Ex - Inspection points
cyanosis clubbing distress precordial bulge scars ventricular impulse
Ex - palpation points
pulse - radial, brachial, femoral
BP, apex beat, heaves, thrills, hepatomegaly
Ex - Auscultation points
HS (4 and back)
murmurs/loud/splitting of sounds
LUNG BASES
normal pulse rates for kids
<1 - 110-160
2-5y - 95-140
5-12y - 80-120
>12y - 60-100
HF in first weeks of life? if obstruction severe? what if duct closes?
usually due to left heart obstruction eg coarctation
if severe -> arterial perfusion can be largely kept due to R>L flow by PDA
duct closure here > severe acidosis, collapse and death unless ductal patency restored
After first week - HF due to? what happens in coming weeks?
likely due to L>R shunt
- coming weeks > pulm resistance falls - progressive increase in L>R shunt -> increased pulm bl flow > pulm oedema and SOB
how long will symptoms of L>R caused HF last? what happens? what if left untreated? treatment for this?
up to age of 3m - as pulm vascular resistance rises in response to L>R shunt
eisenmegers (irreversibly ^ pulm vasc resistance due to chronic raised pulm arterial pressure and flow) now shunt is R>L and teenager is BLUE - needs palliative medication or heart and lung transplant!!!!11
DDx for HF in neonates
neonates - obstructed systemic circulation (duct dependent) ——>
- hypoplastic L heart syndrome
- critical AV stenosis
- severe coarctation
- interrupted aortic arch
DDx for infants
high pulmonary blood flow ->
- VSD
- ASD
- Large persistent DA
DDx for kids/adolescents
Eisenmegers (right)
Rheumatic HD
Cardiomyopathy
8 Ix
examination BP peripheral pulses bloods ECG CXR pulse oximetry echo
mgmt - duct dependent circulation? with L>R shunt and high pulm bf?
prostaglandin infusion - maintains PDA until defect fixed
use diuretics and captopril (ACEi)
