HEART FAILURE IN CHILDREN Flashcards
Heart failure (HF) refers to a complex pathophysiological and clinical syndrome in
which the heart pump is ???
unable to pump sufficient cardiac output to meet tissue
metabolic needs irrespective of cardiac output (CO), which may be normal, low or high.
“Heart failure” is preferred over the older label “congestive heart failure” (AHA
guideline 2005)
Why?
because “Congestion” may not be present or prominent in heart
failure.
It depends on the stage severity.
• Heart failure can lead to shock but not the other way round
T/F
F
Heart failure is NOT shock but either can lead to the other.
Summary: Common causes of Heart failure in Nigerian Children
__________ (commonest-newborns, infants, older children)
Septicaemia
_____________ (infants)
_______________ (infants)
Structural heart defects (congenital & acquired)-VSD, RHD
a) Congenital heart disease
b) Rheumatic Heart Disease following Acute
Rheumatic Fever
Anaemia
Bronchopneumonia
Bronchiolitis
Pathogenesis of Heart Failure
- Increased ________________________
- Increased ________________________
- Depressed ________________________
- Increased __________________ (________________________ states conditions)
- Restricted ________________________/________________________
afterload or pressure overload
- Increased preload or volume overload
- Depressed myocardial contractility
- Increased demand (hypermetabolic states conditions)
- Restricted ventricular filling/ejection time
Clinical Manifestations of Heart Failure
Symptoms and signs of heart failure relate to the following pathophysiological responses:
• Low ___________
• Increased ___________/_________ activity
•____________ congestion
• _______________ congestion
• Impaired _________ performance
cardiac output
sympathetic/adrenergic
Pulmonary; Systemic
myocardial
Clinical Features of Low Cardiac Output
Fatigue/low energy/Easy fatigability (_________ difficulties/_________ feeding
time/suck-rest-suck cycle)
_________
Excessive _________
_________, _________ extremities
Poor _________
Altered consciousness: Irritability, confusion
Dizziness
Syncope
Clinical Features of Low Cardiac Output
Fatigue/low energy/Easy fatigability (feeding difficulties/prolonged feeding
time/suck-rest-suck cycle)
Pallor
Excessive sweating
Cold, clammy extremities
Poor growth
Altered consciousness: Irritability, confusion
Dizziness
Syncope
Clinical Features of Increased Sympathetic Activity
• ______________ * (anxiety, apprehension)
• ______________ *
• Increased ______________cold-sweats (forehead, extremities)
• Cold extremities or mottling*
• Delayed CRT
• Tachypnoea
• ______________*
• Oliguria
• Malaise, fatigue, and anorexia (excess stimulation of skeletal & smooth muscles)
*Features commonly seen in infants
Clinical Features of Increased Sympathetic Activity
• Irritability* (anxiety, apprehension)
• Fast breathing *
• Increased perspiration*
cold-sweats (forehead, extremities)*
• Cold extremities or mottling*
• Delayed CRT
• Tachypnoea
• Tachycardia*
• Oliguria
• Malaise, fatigue, and anorexia (excess stimulation of skeletal & smooth muscles)
*Features commonly seen in infants
Clinical Features of Venous Congestion
Pulmonary Venous Congestion (Lt-sided
HF)
Pulmonary _________
_________
Wheeze
Rhonchi
_________ infection
_________
_________
Clinical Features of Venous Congestion
Pulmonary Venous Congestion (Lt-sided
HF)
Pulmonary oedema
Crepitations
Wheeze
Rhonchi
Chest infection
Tachypnoea
Dyspnoea
Clinical Features of Venous Congestion
Systemic Venous Congestion
(Rt-sided HF)
Increased _______
_______ (tender in acute HF)
Oedema (_______/_______ in newborns & infants, sacral, ankle, pedal, leg)
Hepatojugular reflux
Ascites, pleural effusion, pericardial effusion
Malaise, anorexia, nausea, (GIT wall
congestion), vomiting
Abnormal _______ due to fluid retention.
Systemic Venous Congestion
(Rt-sided HF)
Increased JVP
Hepatomegaly (tender in acute HF)
Oedema (periorbital/facial in newborns &
infants, sacral, ankle, pedal, leg)
Hepatojugular reflux
Ascites, pleural effusion, pericardial effusion
Malaise, anorexia, nausea, (GIT wall
congestion), vomiting
Abnormal weight gain due to fluid retention.
Clinical Features due to myocardial dysfunction
_____________ *
________ rhythm (abnormal diastolic filling)
Pulsus paradoxus & pulsus alternans (due to abnormal systolic work)
_______ failure* FTT
Clinical Features due to myocardial dysfunction
Cardiomegaly*
Gallop rhythm (abnormal diastolic filling)
Pulsus paradoxus & pulsus alternans (due to abnormal systolic work)
Growth failure* FTT
Cardinal signs of CCF in children
• _________
• ___________
• ______________ (Tender in acute or acute on chronic CCF causing right
flank pain due to stretching of the liver capsule by fluids). Liver is not
tender in chronic HF.
• ___________
Tachypnoea
Tachycardia
Hepatomegaky
Cardiomegaly
Complications of CCF
• __________ failure
• __________ shock
• ___________________
• Metabolic and Electrolyte derangements
• Acute renal failure
• __________ infections (__________)
• __________ (chronic CCF)
• __________ (chronic CCF)
• Arrhythmias
• Cardio-renal syndrome (Acute/chronic)
Complications of CCF
• Respiratory failure
• Cardiogenic shock
• Multiple organ dysfunction
• Metabolic and Electrolyte derangements
• Acute renal failure
• Chest infections (Pneumonia)
• Failure to thrive (chronic CCF)
• Pulmonary hypertension (chronic CCF)
• Arrhythmias
• Cardio-renal syndrome (Acute/chronic)
Preload reducing drugs
List 3
Diuretics
Morphine
Aldosterone antagonists
Vasodilators
After load reducing agents
List 3
ACE Inhibitors
Beta blockers
Inotropuc agents like digoxin
