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Heart failure.pptxmmmmmmmmmmmmmmmmmmmmmmmmmmm
- 1. SCHOOL OF CLINICALSCIENCE MAKENI PEADRIATRIC PRESENTATION ON HEART FAILURE IN CHILDERN PREPEARD AND PRESENTED BY SAMUELLA MARY KAMARA =22042 SAMURA KAMARA =22043 LECTURER NAME: DR. AMADU JALLOH
- 2. DEFINITION. CAUSESof HEART FAILURE IN CHILDREN. CLINICAL FEATURES. INVESTIGATION. COMPLICATIONS. TREATMENT OUTLINE
- 3. Human heartbeats 115,000 times a day. Human heart pumps 7500 liters of blood in 24 hrs. Human heart supplies nutrients to each cell of the body through blood vessels. HEART
- 4. Definition: Clinical syndromein which the heart is unable to pump enough blood to Meet metabolic needs of the body. HEART FAILURE
- 5. CARDIAC CAUSES - Congenital heart diseases are the commonest causes - Rheumatic valvular heart disease. - Myocarditis: - Acute hypertension - in infancy (uncommon in ASD & Fallout tetralogy) diseases (in school age) - Dilated cardiomyopathy. - Infective endocarditis. - Acute Cor pulmonale Arrhythmia: - Broncho pulmonary dysplasia. - Supraventricular tachycardia - Complete heart block. CAUSES OF HEART FAILURE IN CHILDREN.
- 6. -Viral (CoxachieA, B & Echo viruses) - Severe anemia -Toxic (drugs, diphteria). - Protozoal (e.g. Chagas disease). Nutritional: - Beri Beri - Carnitine deficiency - Kwashiorkor. - Keshan disease (Selenium deficiency NON CARDIAC
- 7. Clinical features - Symptoms: Infants: - Poor feeding: Tachypnea and cold sweating during feeding. - Poor weight gain. Older child: - Dyspnea on exertion. - Effort intolerance( Fatigue). - Ankle oedema. - Palpitation. -Pain abdomen Clinical features
- 8. ii- Signs: a- Compensatory response to heart failure. 1- Tachycardia, gaiiop rhythm & weak pulse. 2- Cardiomegaly is almost always present. 3- Cold, sweaty skin (due to tsympathetic derive) CLINICAL FEATURES – CONT..
- 9. b- Pulmonarycongestion 1- Tachypnea (Fast Breathing). 2- Exertional dyspnea - Infant ~ poor feeding. - Child ~ dyspnea & orthopnea 3- Chest wheezes & fine crepitations. 4-Tachycardia ( Fast Heart Rate). CLINICAL FEATURES –CONT..
- 10. c- Systemiccongestion: 1- Enlarged tender liver (may be absent in early left sided failure). 2- Congested neck veins; hard to detect in infants due to short neck. 3- Oedema~ generalized start in ankles (sacral in bed ridden) 4- Oedema in infants usually involve eye lids and the sacrum CLINICAL FEATURES – CONT..
- 11. Heart failure isclinical diagnosis but further investigations can be done; 1- Chest X-ray: - Cardiomegaly 2- Echo: - Confirm left ventricle dysfunction (decreased ejection fraction & increased ejection time). - Confirm chamber enlargement. - May detect cause of failure. 3- ECG: -Detect arrythmias. INVESTIGATIONS
- 12. CBC Electrolytes. Cardiac Biomarkers- increase in ventricular dilation. - Brain nautriuretic peptide( BNP)- More than 100pg/ml. - N-terminal prohormone BNP (NT-pro BNP). Liver function Tests. Renal Function Tests. Other Investigations.
- 13. Cardiac Arrhythmia Thrombo-embolism. Pulmonary edema. Liver dsyfunction Renal failure Electrolyte imbalance Failure to thrive- low weight and height. COMPLICATIONS.
- 14. 1 Hospitalization& position - Bed rest in semisitting position - 0 2 inhalation. 2 Feeding. - Low salt diet (to avoid further salt & water retention). 3 Fluid Restriction. - If parenteral fluids is indicated ; give restricted maintenance fluids Anemia- Iron Supplements. Blood transfusion. TREATMENT/ Supportive Management.
- 15. 2- Diuretics( -1- cardiac pre-load) 1- Frosemide ~ I. V. = 1 mg I kg I dose. ~ oral = 2 mg I kg. -Side effect: Hypokalemia & Alkalosis~ may increase digitalis toxicity. 2- Spironolactone (k-sparing diuretic) ~ oral = 2 mg I kg. 3- Thiazide ~ oral = 20-40 mg I kg. TREATMENT/ SPECIFIC MANAGEMENT.
- 16. 3- Digitalis: Digoxin is the commonest. • Functions of digitalis : -t myocardial contractility (inotropic drug) TREATMENT – CONT..
- 17. 1- Getbaseline ECG & electrolytes (especially potassium) 2- Loading dose is given within 24 hours: ~ ½ the total digitalizing dose (TDD) immediate. ~ ¼ TDD after 8 hours~ ¼ % TDD after another 8 hours. 3- Maintenance dose ( = ¼ TDD) is given in two divided doses after 12 hours. Digitalization:
- 18. Oral TDD (mglkg) }= 75% of oral TDD. Premature 0.02 New born 0.03 Infants< 2 y 0.05 Child > 2 y 0.03
- 19. • 1- Causes: -Accidental over dose. - Renal impairment. - Increased myocardial sensitivity e.g.: hypokalemia & rheumatic carditis. - Drug interactions. 2- Signs: -Anorexia, vomiting - Drowsiness & visual disturbance in older child. - Bradycardia - Worsening of heart failure. - Arrythmias (supraventricular arrythmia & heart block). - Serum digitalis level > 2 ng/ml. Digitalis toxicity
- 20. - ContinuousECG monitoring. - Stop digitalis - Correct hypokalemia -Correct arrythmias by: a- Atropine 0.01 mg/kg 6 hours for heart block. b- lidocaine for ventricular arrythmia - Increase excretion of digoxin by Digoxin immune Fab (Digibind), slow I.V. 3- Treatment:
- 21. 4- Vasodilators: Role: - Act by -1- cardiac after load ~ increase stroke volume. -Useful in: - hypertensive heart failure. - Dilated cardiomyopathy. - Large left to right shunt. - Severe MR and AR. Types: - ACE inhibitors e.g. Captopril, Enalapril -Hydralazine. -Nitro-glycerine I.V. infusion (used in acute pulmonary oedema). Treatment- Cont..
- 22. 5- Sedation~ morphine subcutaneous in severe excitation. 6- Severe heart failure with acute pulmonary oedema~ Aminophylline i.v. infusion is added. 7- Search for & treat the cause e.g.: - Rheumatic carditis ~ steroids. - Renal failure ~ dialysis. - Surgery e.g. for congenital heart disease
- 23. CLASS INFANT CHILD 1Asymptomatic No limitations Asymptomatic No limitations 2 Mild tachypnea or diaphoresis with feeding No growth failure. Dyspnea on exertion. 3 Marked tachypnea or diaphoresis with feeding Prolonged feeding times FTT Marked dyspnea on exertion FTT 4 Tachypnea, retractions, grunting, or diaphoriess at rest Tachypnea, retriactiona, grunting, Clinical Assement of severity in children. (THE MODIFIED ROSS HEART FAILURE CLASSIFICATION IN CHILDREN ).
- 24.
- 25. BABY NELSON, FIFTHEDITION AUSTRALAI PEDIATRIC ASSOCIATION REFERENCES: