Congestive cardiac failure Flashcards
Causes
Cardiac
L to R shunt, RHD
Obstructive lesion
Cardiomyopathy, myocarditis, arrythmia, malnutrition
Non-cardiac
Fluids, low albumin, anemia
Hypertension
Anemia, sepsis
Approach to CCF
History
Examination
Investigation
Treat
History
Infant:
Poor feeding, difficulty breathing, excessive cold sweating
Child:
Difficulty breathing, fatigue, swelling
Examination
Venous congestion (orbital oedema, JVP, pulmonary oedema, orthopnoea, dyspnoea, tachypnoea, hepatomegaly, ascites) Low cardiac output (pallor, sweating, syncope, fatigue, poor growth) Compensatory mechanisms (cardiomegaly)
Investigations
CXR ECG Echo Bloods Urine dipstix
General management
Place in semi-fowler's position O2 Salt restriction High energy diet Daily weighing Find and treat underlying cause
Specific management
Decrease preload (diuretics) Decrease afterload (vasodilators) Increase myocardial function (inotropes) Control compensatory mechanisms (beta blockers)
Transfuse in anemia HAART Correct metabolic abnormality Treat arrythmia Cardiac surgery HT medication
Name mechanisms of systolic dysfunction cardiac failure
Myocarditis
Dilated CMO
Malnutrition
Ischaemia
Name mechanisms of diastolic dysfunction cardiac failure
Pericardial tamponade
Restrictive CMO
Hypertrophic CMO
Name causes of volume overload
Cardiac - L to R shunt - RHD Non-cardiac - fluids - hypoalbumin - anemia
Name causes of pressure overload
Cardiac
- obstructive lesions
Non-cardiac
- hypertension
What is the mechanism of the clinical features of CCF?
Decr CO
- Beta adrenergic -> tachycardia
- Alpha adrenergic -> vasoconstriction
- RAAS -> oedema
What are the most likely causes of CF in a fetus?
Anemia Arrythmia Myocardial dysfx Large AVM Structure heart disease
What are the most likely causes of CF in infant<2mo?
Structural heart disease Myocardial disease Metabolic Respiratory Anemia Sepsis
What are the most likely causes of CF in older children?
Congenital and acquired heart disease Cor pulmonale Hypertension Renal failure Drugs
