Lec 11 : Heart Failure (Pediatrics) Flashcards
Oxygen delivery to tissues is determined primarily by
arterial O2 content
x
cardiac output
The cardiac output is a product of the heart rate and stroke volume. What three factors determine the stroke volume?
preload
contractility
afterload
The following are main causes of heart failure in children EXCEPT
a. myocardial diseases
b. volume overload
c. pressure overload
d. complex heart diseases
a. myocardial disease
Myocardial diseases (e.g. MI) are common causes of heart failure in adults.
Which of the following neurohormonal compensatory mechanisms increases preload?
a. sympathetic nervous system stimulation
b. renin-angiotensis-aldosterone system activation
c. arginine vasopressin production
d. A & B only
e. AOTA
e. AOTA
SNS stimulation causes increased HR and contractility.
RAAS activation causes sodium and water retention.
AVP production prevents diuresis.
The increase in peripheral vascular resistance can be mediated by
a. angiotensin II
b. catecholamine
c. prostaglandin E1
d. A & B only
e. AOTA
c. prostaglandin E1
PGE1 is a potent vasodilator and hence decreases PVR.
Pulmonary venous congestion is primarily caused by the following EXCEPT
a. increased pulmonary blood flow
b. increased left ventricular end diastolic pressure
c. increased left atrial pressure
d. NOTA
a. increased pulmonary blood flow
Increased PBF primarily causes pulmonary arterial congestion.
Tachypnea, dyspnea, and orthopnea are symptoms of what heart failure manifestation?
pulmonary congestion
Increased sympathetic stimulation causes the following EXCEPT
a. tachycardia
b. diaphoresis
c. arrhythmia
d. A & B only
e. AOTA
e. AOTA
Cold extremities is brought about by what mechanism?
peripheral vasoconstriction
This is to have preferential flow to vital organs such as brain, heart, and kidneys.
This is the hallmark of heart failure in infants. It is rarely / not found in adult heart failure.
intermittency of feeding
Feeding is the only other strenuous activity of infants aside from crying and playing.
A normal six month old baby should be able to consume 210 ml of milk in how many minutes?
30 minutes
[ (age in months) + 1 ] x 30 ml = amount consumed in 30 min
Give other manifestations of heart failure in infants.
diaphoresis
poor weight gain
repeated respiratory tract infection
agitation & irritability
The FAILD acronym of heart failure signs and symptoms stands for the following EXCEPT
a. L - lacks color
b. A - anxiety
c. D - diaphoresis
d. D - distress
e. NOTA
e. NOTA
F - failure to thrive A - anxiety I - irritability L - lacks color D - diaphoresis D - distress
This heart failure sign is caused by prolonged tension of the diaphragm due to respiratory distress.
Harrison’s groove
This auscultatory finding indicates poor ventricular compliance and is a specific sign of heart failure.
S3 gallop
A sustained heart rate > 220 bpm in an infant with heart failure means that the tachycardia
a. is secondary to heart failure
b. is causing the heart failure
c. is normal and compensatory
d. A & B only
e. AOTA
b. is causing the heart failure
secondary to HF: >160 (infant) or >100 (older child)
cause of HF: >220 (infant) or >180 (older child)
The presence of rales secondary to heart failure is unusual in infants. This may rather suggest what concurrent disease?
pneumonia
T/F: Splenomegaly is not associated with congestive heart failure.
T
Which of the following signs of heart failure is rare in children?
a. cool extremities
b. weak peripheral pulse
c. slow capillary refill
d. peripheral edema
d. peripheral edema
Peripheral edema is rare in children. It may be due to concurrent presence of tricuspid regurgitation.
According to the Ross classification of heart failure, an infant with marked tachypnea or diaphoresis when feeding is classified as
Class III
Class I - asymptomatic
Class II - mild
Class III - marked
Class IV - symptomatic at rest
The Ross classification is roughly similar to the New York Heart Association classification.
T/F: A child with a cardiothoracic ratio of 0.52 has cardiomegaly.
F
Cardiomegaly in children presents with a CT ratio of >0.55.
This is the most common cause of heart failure during the first week of life.
transposition of the great arteries
This is the most common cause of heart failure in school-age children.
rheumatic fever and rheumatic heart disease
The treatment goals of heart failure management include the following EXCEPT
a. elimination of primary cause
b. augmentation of oxygen delivery
c. reduction of metabolic demands
d. enhancement of compensatory mechanisms
e. NOTA
d. enhancement of compensatory mechanisms
Compensatory mechanisms are detrimental in the long term.
This drug is used to medically close a patent ductus arteriosus.
indomethacin
Indomethacin is a PGE1 inhibitor. PGE1 keeps the PDA open.
To temper the compensatory mechanisms, we need to
a. increase preload
b. decrease afterload
c. enhance LV remodelling
d. NOTA
e. AOTA
b. decrease afterload
decrease preload decrease afterload prevent LV remodelling decrease catecholamines block neurohomonal mechanisms
The following are used to augment myocardial contractility EXCEPT
a. lanoxin
b. furosemide
c. dobutamine
d. milrinone
e. NOTA
b. furosemide
Furosemide is a diuretic which decreases preload.
ACE inhibitors work mainly by
a. increasing myocardial contractility
b. decreasing catecholamine release
c. decreasing afterload
d. promoting diuresis
e. NOTA
c. decreasing afterload
ACE inhibitors prevent the conversion of angiotensin I to angiotensin II thereby preventing ATII vasoconstrictive effects. This decreases the peripheral vascular resistance and hence the afterload.
A vasodilator that is also used in the treatment of angina pectoris.
nitroglycerin
The worst type of heart failure is
the failure to love
