Congestive Heart Failure (paediatric)


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

  1. Preload (diastolic loading of the ventricles)
  2. Afterload (systolic loading of the ventricles)
  3. Cardiac contractility
  4. Heart rate

Aetiology

Volume Overload

  • Left to right shunt (VSD,PDA)
  • Anaemia

Pressure Overload

  • LV outflow obstruction (AS, coarctation)

Myocardial Dysfunction

  • Dysrhythmia
  • Infection
  • Autoimmune (SLE, ARF)
  • Poisoning (TCA, digitalis)

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)


Content by Dr Íomhar O' Sullivan 01/12/2008. Last review Dr IOS 16/06/21.