39. Acute and chronic heart failure.

Question 1

Acute and chronic HF

CLINIC

Answer 1

• INFANTS: Poor feeding, failure to thrive, tachypnea, diaphoresis with feeding
• physical examination depends on the presence of pulmonary &/ systemic venous congestion
• Tachykardia, gallop rythm and thready pulses
• if left-sided failure is predominant: tachypnea, orthopnea, wheesing pulmonary edema
• right-sided HF predominant: hepatomegaly, edema, distended neck veins

Question 2

Acute and chronic HF

Treatment (very general)

Answer 2

• directed at improving myocardial function
• optimize pre- and afterload
• Diuretics, inotropic suppport and afterload reduction
• Long-term therapy with beta-blockers may be beneficial (controversial)
• Spironolactone (effect on cardiac remodelling

Question 3

ROSS

(basically NYHA for infants/chil &/ dren)

Answer 3

• I
  
  • no limitation
• II
  
  • mild tachypnea &/ diaphoresis in older children with feeding, dyspnea on exertion, no growth failure
• III
  
  • marked tachypnea &/ diaphoresis with feeding &/ on exertion, prolongued feeding time, growth failure
• IV
  
  • Symptomatic @ rest with tachynea, retractions, grunting, diaphoresis

Question 4

Acute and chronic HF

Imaging

Answer 4

X-Ray => no cardiomegaly = no HF

ECHO: Vitien? Klappenanomalien? Anatomie?

Question 5

Treatment of HF

Answer 5

• General:
  
  • Rest, Oxygen, sodium & fluid restriction
• Diuretics:
  
  • Furosemide
• Inotropic agends:
  
  • Digitalis, Dopamine, Dobutamine, Milrinone
• Afterload reduction
  
  • Hydralazine
  • Nitroprusside
  • Captopril/Enalapril
• Other measures:
  
  • mechanical counterpulsation
  • transplantation
  • extracorporal membraneoxygenation
  • Carvedilol