Cardiac failure in a child Flashcards
List 4 causes of heart failure in neonates.
Neonates = obstructed (duct-dependent) systemic circulation
- hypoplastic left heart syndrome
- critical aortic valve stenosis
- severe coarctation of the aorta
- iterruption of the aortic arch
List 3 causes of heart failure in infants.
Infants = high pulmonary blood flow
- VSD
- AVSD
- Large persistent ductus arteriosus
List 3 causes of heart failure in older children and adolescents.
Older children and adolescents = right or left heart failure
- Eisenmenger syndrome (right HF only)
- Rheumatic heart disease
- Cardiomyopathy
What are the signs and symptoms of heart failure? What about right heart failure?
- Breathlessness (particularly on feeding or exertion)
- Sweating
- Poor feeding
- Recurrent chest infections.
- Poor weight gain or faltering growth
- Tachypnoea
- Tachycardia
- Heart murmur, gallop rhythm
- Enlarged heart
- Hepatomegaly
- Cool peripheries.
RHF - ankle oedema, sacral oedema, ascites
What are some causes of right heart failure (NB: uncommon in developed countries)?
Long standing rheumatic heart disease or pulmonary hypertension, with tricuspid regurgitation and right atrial dilatation
What kind of shunting causes heart failure in neonates up to 3 months?
First week of life: left heart obstruction e.g. coarctation of the aorta, if severe then arterial perfusion may be predominantly by right-to-left flow of blood via the arterial duct, so-called duct-dependent systemic circulation. Closure of duct rapidly leads to severe acidosis, collapse and death unless ductal patency is restored.
After this, heart failure if most likely due to left-to-right shunts. As pulmonary vascular resistance falls, there is an increase in this shunting and increasing pulmonsary blood flow causing pulmonary oedema and breathlessness. These symptoms increase up to 3 months of life then improve.
What is a complication of prolonged (>3 months) left-to-right shunting in neonates?
Untreated raised pulmonary vascular resistance leads to Eisenmenger syndrome
= irreversibly raised pulmonary vascular resistance resulting from chronically raised pulmonary arterial pressure and flow. The shunt changes to right-to-left causing cyanosis in a teenager.
What is the management of Eisenmenger syndrome in a teenager who becomes cyanotic?
Only option: heart-lung transplant
(medication can palliate symptoms)
Compare and contrast the symptoms and causes of left-to-right and right-to-left shunts.
Left-to-right
- Symptoms: breathless or asymptomatic
- Causes: ASD, VSD, PDA
Right-to-left
- Symptoms: cyanosis
- Causes: Tetralogy of Fallot, transposition of the great arteries (TGA)
What are the symptoms and causes of common mixing heart diseases?
Common mixing:
- Symptoms: breathless and cyanosed
- Causes: AVSD, complex congenital heart disease
Compare and contrast the symptoms and causes associated with obstructive heart disease in sick neonates and well children.
Well children - asymptomatic. Causes: AS, PS, adult-type CoA
Sick neonates - collapsed with shock. Causes: hypoplastic left heart syndrome (HLHS), coarctation.
A 5-week-old female infant was referred to hospital because of wheezing, poor feeding and poor weight gain during the previous 2 weeks. Before this she had been well. Her routine neonatal examination had been normal. She was tachypnoeic (50–60 breaths/min) and there was some sternal and intercostal recession. The pulses were normal. There was a thrill, a pansystolic murmur at the lower left sternal edge and a slightly accentuated pulmonary component to the second heart sound. There were scattered wheezes. The liver was enlarged, palpable at two finger breadths below the costal margin. The ECG was unremarkable. The chest radiograph showed cardiomegaly and increased pulmonary vascular markings. What is the suspected diagnosis? What is shown on the echocardiogram below?
Left-to-right shunt causing heart failure during a time in infancy when pulmonary resistance is falling. (Outcome: defect closed spontaneously)
Echo: A shows medium sized VSD, B shows colour Doppler showing left-to-right shunting during systole , C shows small right-to-left shunt during diastole.
