Cardiac failure in children

Question 1

What is cardiac failure in children? causes/RF

Answer 1

heart defects leading to early cardiac (R or L) failure -very dangerous

neonate causes - duct dependent -caused by outflow obstructions (aortic/pulm stenosis, coarctation of the aorta, L hypoplastic heart)
Toddler - heart defect dependent (L to R shunts -causing pulm HTN) - VSD, PDA, ASD
Children- eisenmerger syndrome (R - L shunt), rheumatic HD, Arrythmias
Other - volume overload (aneamia, sepsis), Pressure overload

Question 2

Signs and Sx of cardiac failure in children

Answer 2

the timeline depends on which cause -neonate>toddler>children

Poor weight gain, poor feeding, fatigue, SOB, reccurent chest infections

Signs -
RR up, HR up
Resp distress, pallor
cyanosis, cold extremities
Sign of venous congestion (pitting oedema, ascites), hepatomegaly, enlarged heart, insufficient CO
Murmurs/gallop rythm, abnormal pulse rythmes

Question 3

Ix of cardiac failure in children

Answer 3

O2 - can be low if cyanotic causes (R-L shunts)
BP -can be raised/differnt in arm legs
HR up, RR up,
FBC -aneamia, sepsis
U&Es
BNP

CXR -enlarged heart, egg on side, boot shaped, etc
ECG -depends on cause by RVH, LVH
Echocardiography -diagnostic for any defect -always needed

Question 4

Management of cardiac failure in children

Answer 4

Multi faceted approach with these goals
Reduce volume overload /preload-
diuretics (furosemide) or GTN

Improve contractility
dopamine
or digoxin, adrenaline

Reduce afterload -
oral ACEi

Improve O2 delivery
b blockers (carvediol)

Improve nutrition

IF CYANOTIC -always want to maintain PDA if early enough -prostaglandins