Cardiology

Question 1

What are Causes of heart failure in infancy?

Answer 1

• CHD: cyanotic ( incr. pulm BF) / acyanotic (incr. pulm BF/ obstruction to vent. BF)
• Infection/inflam: myocarditis
• Cardiomyopathy
• Tachyarrythmia
• Bradyarrythmia

Question 2

Mx heart failure?

Answer 2

• position at 60 degrees
• O2
• restrict fluids ( 60ml/kg/ day neonates): breast milk / low sodium milk
• inotropes: e.g.
  - Digoxin: (5-10mg/kg/day, IM/oral) IV digoxin not recommended and must be given under ECG
  - doputamine: for severe failure
• Diuretics:
  - Furosimide = most effective in acute failure
  - Spirinolactone: can be combined with furosimide
• Vasodilators
  - esp. Dilated Cardiomyopathy
  - ACE Inhibitors commonly used : Captopril
  - gradual introduction
  - monitor BP and electrolytes

Question 3

How does cardiac failure present in infancy vs. childhood

Answer 3

Infancy:

Symptoms

• rapid breathing
• poor color
• sweating
• inability to complete feeds
• failure to gain weight

Signs

• fluid overload: suspended increase in weight (dependent oedema = late sign), peri orbital oedema, hepatosplenomegaly
• tachycardia
• gallop rhythm

Childhood:
- adult symptoms

Question 4

What measures need to be taken when diving IV digoxin

Answer 4

-Give under ECG and at 3/4 of oral/IM dose

Question 5

Do diuretics reduce pre-load or after load

Answer 5

Pre-load

Question 6

What special properties does spirinolactone have?

Answer 6

Potassium Sparing

Question 7

Most important assessment of control in cardiac failure?

Answer 7

-babies ability to feed adequately ( check weight gain)

Question 8

Aim of treatment in CCF?

Answer 8

• reducing preload/ volume overload
• improving contractility
• after load reduction

Question 9

What supplementation is important to consider w/ diuretics?

Answer 9

Potassium (1-2mmol/day) if diuretic causes potassium loss