Cardiology - Heart Failure

Question 1

Definition

Answer 1

Paediatric heart failure refers to the heart’s ability to contract and pump blood is impaired, leading to an inadequate supply of oxygen and nutrients to the body’s tissues and organs.

Question 2

Aetiology

Answer 2

• Congenital heart defects
• Infections (endocarditis, myocarditis)
• Cardiomyopathies
• Tachyarrhythmias
• Myocardial ischaemia (anomalous left coronary artery)

Question 3

Pathophysiology

Answer 3

Impairment of the hearts ability to effectively pump blood = inadequate perfusion of O2 and nutrients to the body. The dysfunction of the heart -> compensatory responses:
1. Cardiac dysfunction = impaired contractility, reduced stroke volume, decreased cardiac output
2. Increased pre-load: via increased venous constriction and fluid retention by kidneys = increase SV -> improve cardiac filling. However can lead to fluid overload.
3. Activation of neurohormonal systems: sympathetic nervous system + RAAS = catecholamines released + increase heart rate and cardiac contractility.
4. Myocardial remodelling: prolonged stress on heart leads to remodelling = hypertrophy of cardiac myocytes, fibrosis, and alterations of extracellular matrix.
5. Impaired peripheral circulation: cardiac output decreases = inadequate delivery of O2 = tissue hypoxia, and metabolic derangements, leading to symptoms such as fatigue, exercise, intolerance and poor growth in children.

Question 4

Signs and symptoms in infants

Answer 4

Difficulty feeding
Faltering growth
Exercise intolerance
Abdominal pain and vomiting (esp on exertion)
Fatigue
Poor appetite
Murmur
SOB

Question 5

Signs and symptoms in adolescents

Answer 5

Exercise intolerance
Fatigue

Question 6

Diagnosis

Answer 6

1st line: BNP, FBC, U+E’s, CRP, LFT’s, bone profile
GS: Echo
Other: CXR, ECG

Question 7

Management

Answer 7

Conservative:
- Fluid restriction and feeding plan from dieticians
- Respiratory support - Supplemental O2 (if hypoxic)
Medical: Management
- Diuretics with inotropic support if needed
Surgical:
- Correction of anatomical defect (if present) causing heart failure. - Transplant in end-stage cases

Question 8

Complications

Answer 8

Pulmonary oedema,
Arrhythmias,
Growth and development delay