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CONGESTIVE HEART FAILURE.ppt in cardiovascular
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- 2. 2 • Most heartdiseases in young children are congenital. The cause is rarely known. • The prognosis in many cases is poor, due to lack of suitable treatment. • Older children are more likely to have acquired heart diseases such as rheumatic fever, endomyorcardial fibrosis, e.t.c.
- 3. 3 • The heartmay also be affected in many systemic disorders, e.g., infections, malnutrition, anaemia, electrolyte disturbances. • The prognosis and treatment of these are related to the underlying cause. Adequate treatment can help in many of these cases.
- 4. 4 Congestive heart failure •Congestive heart failure is inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body. • In children CHF most frequently occurs secondary to structural abnormalities (e.g. septal defects). • CHF can also occur because of excessive demands on a normal heart muscle, such as sepsis or severe anemia.
- 5. 5 Pathophysiology • Heart failureis often separated into 2 categories: right sided and left sided failure. • In right sided failure, the right ventricle is unable to pump blood effectively into the pulmonary artery, resulting in increased pressure in the right atrium and systemic venous circulation. • Systemic venous hypertension causes hepato- splenomegaly and occasionally edema.
- 6. 6 • In leftsided failure, the left ventricle is unable to pump blood into the systemic circulation, resulting in increased pressure in the left atrium and pulmonary veins. • The lungs become congested with blood, causing elevated pulmonary pressures and pulmonary edema.
- 7. 7 • Although eachtype of heart failure produces different signs and symptoms, clinically it is unusual to observe solely right or left sided failure in children. • Since each side of the heart depends on adequate function of the other side, failure of one chamber causes reciprocal change in the opposite chamber.
- 8. 8 • If abnormalitiesprecipitating congestive heart failure are not corrected, the heart muscle becomes damaged. • Despite compensatory mechanisms, the heart is unable to maintain an adequate cardiac output. • Decreased blood flow to the kidneys continues to stimulate sodium and water reabsorption, leading to hypervolemia, increased workload on the heart, and congestion in the pulmonary and systemic circulations.
- 9. 9 Signs of cardiacfailure • In the diagnosis of cardiac failure in children, look carefully for the following features: • Tachycardia- rapid pulse. In newborns and infants up to 1 year, the normal pulse rate is 80 -160/minute, in older children 70- 120/minute (with 10 extra for every degree of fever over 370 c).
- 10. 10 • Tachypnoea- rapidrespiration of more than 60/minute in infancy or more than 40/minute in older children. • Dyspnoea- shortness of breath with deeper and more rapid breathing. The respiratory symptoms are due to pulmonary congestion (backward failure of the left heart) dyspnoea is usually present at rest but always more pronounced after exertion. In infants, feeding difficulties are often the presenting complaint.
- 11. 11 • Oedema andother signs of raised venous pressure. Enlargement of the liver is the most frequent and important sign. Peripheral oedema is an early symptom of cardiac failure in children. • The cause is congestion with blood unable to enter the right heart (back ward failure of the right heart). • The increased venous pressure also may cause engorgement of the neck veins.
- 12. 12 • Tiredness andfailure to thrive. These are caused by insufficient blood circulation. Retarded development often is found in small children with congenital heart disease due to insufficient oxygen supply to the growing tissues.
- 13. 13 • The signsand symptoms of cardiac failure can be divided into 3 groups: Impaired myocardial function Pulmonary congestion Systemic venous congestion.
- 14. 14 Impaired myocardial function Tachycardia Sweating (inappropriate) Decreased urine output Fatigue Weakness Restlessness Anorexia Pale cool extremities Weak peripheral pulses Gallop rhythm Cardiomegaly
- 15. 15 Pulmonary congestion Tachypnoea Dyspnoea Nasal flaring Exerciseintolerance Cough, hoarseness Cyanosis Wheezing Grunting
- 16. 16 Systemic venous congestion Weightgain Hepatomegaly Peripheral edema especially periorbital Ascites Neck vein distention
- 17. 17 Management of CHF •Examine the patient carefully for signs of cardiac failure. • Try to find out the underlying disease or cause of dysfunction, e.g. congenital or acquired heart disease, severe anaemia, severe pneumonia or renal failure, and treat specifically if possible. • Any child with congestive heart failure should be referred to hospital whenever possible.
- 18. 18 • Check weightof child, record pulse and respiration carefully at 2 hourly intervals, and indicate the exact time of any drugs given.
- 19. 19 The goals oftreatment are to: 1) Improve cardiac function 2) Remove accumulated fluid 3) Decrease cardiac demands 4) Improve tissue oxygenation and decrease oxygen consumption.
- 20. 20 To decrease cardiacdemands • Bed rest and comfort. • Try to relieve anxiety. • Sedation if necessary: diazepam 0.1- 0.3mg/kg/day in 2-3 divided doses.
- 21. 21 To remove accumulatedfluid and sodium • Treatment consists of diuretics, possible fluid restriction, and sodium restriction • Diuretics: give furosemide (lasix) 1mg/kg I.V in acute cardiac failure, but long term treatment with diuretics is rather dangerous and should not be given without electrolyte control. Spironolactone (K+ sparing diuretic). To improve tissue oxygenation and decrease oxygen consumption. Supplemental humidified oxygen.
- 22. 22 To improve cardiacfunction; • Digitalization is most important: • Digoxin is given orally or intramuscularly. In severely sick or vomiting children, the i.m route is recommended to start with. • note: if digoxin is given i.m. or i.v., the digitalizing dose is 75% of the oral dose.
- 23. 23 Severe anaemia • Givepacked blood cells 10mls/kg. • Do not give more fluid than 100ml/kg/day for older children to avoid unnecessary work for the heart muscle. • Find out the cause of anaemia (malaria? Hook worm? Sickle cell disease? Severe malnutrition?) and treat accordingly.
- 24. 24 Severe pneumonia • Giveantibiotics parenterally • Feed by nasogastric tube • Suction regularly to avoid airway obstruction. • Apply tepid sponging in case of fever.
- 25. 25 Renal failure • Keepa careful input/output balance chart. • Treat hypertension if present
- 26. 26 Nursing considerations • Admittedto the hospital where intensive nursing care is available. • Positioned for optimum ventilation and oxygen administered. • IV access is established. • Cardiac and respiratory function is monitored continuously using a cardiac monitor and pulse oximeter to monitor oxygen saturation. • Urine output monitored.