Background
- Inability of cardiac output to meet metabolic demands
- Predominantly the result of congenital heart disease
- 95% present within the first year of life (most in first 3/12)
Pathophysiology
- Preload (diastolic loading of the ventricles)
- Afterload (systolic loading of the ventricles)
- Cardiac contractility
- Heart rate
Aetiology
Volume Overload
- Left to right shunt (VSD,PDA)
- Anaemia
Pressure Overload
- LV outflow obstruction (AS, coarctation)
Myocardial Dysfunction
Onset
Condition |
Presentation |
|---|---|
Hypoplastic left heart |
Week 1 |
Coarctation of the aorta |
Week 1 |
Complete AV canal |
Week 2 |
PDA |
Week 2 |
VSD |
Week 4 |
Condition |
Presentation |
|---|---|
Transposition |
Week 1 |
TAPVR |
Week 1 |
Ebstein's anomaly |
Week 2 |
Pulmonary stenodis |
Week 2 |
Tetralogy of Fallot |
Week 4 |
Symptoms / signs of CCF
Clinical - Cyanosis (unresponsive)
- Poor feeding, (plus increased resp. work)
- FTT
- Sweating
- LRTIs
- Pallor & tachypnoea
- Tachycardia (gallop), cardiomegaly
- Hepatomegaly and oedema late
- Shock (long CRT, cool peripheries - DDx septic)
- CXR = Cardiomegaly (CT ratio > 0.55) & pulmonary oedema
Management
- ABC'S
- O2
- Thermoregulation
- Medications
- Digoxin, Dopamine
- Diuretics, Vasodilators
Prostaglandins
- Employed in cases of ductus-dependent lesions
- Severe coarctation
- Hypoplastic left heart
Prostaglandin E1 is the drug of choice (0.05-0.1ug/kg/minute)