Paeds: Congestive Cardiac Failure Flashcards
1
Q
Causes in neonates
A
Neonates
2
Q
Causes in infants
A
- VSD
- AVSD
Large PDA
3
Q
other causes of CCF
A
- Cardiomyopathy
- Myocarditits: viral, rheumatic fever
- Endocarditits
- Myocardial ischaemia: Kawasaki disease
- Tachyarrhythmia:SVT
- Acute hypertension
High-output: severe anaemia, thyrotoxicosis; AV malformations
4
Q
HF in neonate is due to
A
L heart obstruction (co-arctation of the aorta)
IF it is very severe then arterial perfusion may be mostly R-L via the arterial duct “duct dependent”.
So closure of the duct rapidly causes death
5
Q
HF in infants is due to
A
L to R shunts
Symptoms of HF will last up to 3 months and may then improve as the resistance for the r sie increases to compensate for the L-R shunt.
If left untreated then Eisenmengers syndrome occurs
6
Q
Eisenmengers
A
Irreversibly increased pulmonary vascular resistance due to chronically raised pulmonary pressure and flow.
7
Q
Symptoms of Poor tissue perfusion
A
- Fatigue
- Poor exercise tolerance
- Confusion
- Sweating
Poor feeding and failure to thrive
8
Q
Congestion of circulation
A
- Dyspnoea
- Pleural effusion
- Pulmonary oedema
- Hepatomegaly
- Peripheral oedema
Tachycardia/”gallop” rhythm
9
Q
Pathophysiology
A
- Increased afterload (pressure work)
- Increased preload (volume work)
- Myocardial abnormalities
- Tachyarrhythmias
10
Q
Signs:
A
- Increased resp rate and heart rate
- Hear murmur – gallop rhythm
- Enlarged heart
- Hepatomegaly
- Cool peripheries
11
Q
Investigations:
A
- CXR cardiac enlargement, Lung - oligaemic, oedema
- Echocardiopraphy: congenital heart defects
- Arterial blood gas: reduced PO2/metabolic acidosis
- ECG: not diagnostic but may assist
- Serum electrolytes: hyponatraemia due to water retention
12
Q
Mx
A
- Bed rest and nurse in semi-upright position: infants in chair/seat
- Supplemental oxygen (not in left to right shunt)
- Diet: Sufficient calorie intake
- Diuretics
- Angiotensin converting enzyme inhibitors
