Pediatric Congestive Heart Failure

Sep 16, 2019 admin TIM MẠCH 0

Pediatric Congestive Heart Failure

Aka: Pediatric Congestive Heart Failure, Congestive Heart Failure in Children, CHF in Children

II. Causes: General

  1. See Congenital Heart Disease Causes
  2. Left heart obstructive disease
    1. Hypoplastic Left Heart Syndrome
    2. Aortic Stenosis
    3. Aortic Coarctation
  3. Large shunt with pulmonary overflow
    1. Ventricular Septal Defect
  4. Pump Failure
    1. Myocarditis (e.g. HH6, enterovirus, Parvovirus, Kawasaki’s Disease)
    2. Cardiomyopathy

III. Causes: Age of presentation

  1. Week 1: Hypoplastic Left Heart Syndrome
  2. Week 2: Aortic Coarctation
  3. Week 4-12: Ventricular Septal Defect
  4. After Week 12: Valvular heart disease, Myocarditis

IV. Symptoms

  1. Poor feeding
  2. Diaphoresis with feeding

V. Signs

  1. See Congenital Heart Disease
  2. See Pediatric Murmur
  3. See Pediatric Vital Signs
  4. Biventricular failure is the rule
  5. S3 Heart Sound
  6. Tachypnea and other signs respiratory disease
  7. Tachycardia (out of proportion to condition)
  8. Hepatomegaly
  9. Pallor

VI. Labs

  1. Complete Blood Count (CBC)
  2. Brain Natriuretic Peptide (BNP or ntBNP)
  3. Venous Blood Gas
  4. Serum Lactate
  5. Thyroid Stimulating Hormone (TSH)
  6. Serum Troponin
    1. Increased in Myocarditis
    2. ALCAPA (Left Main Coronary Artery Disorder) can predispose to childhood Acute Coronary Syndrome

VII. Imaging

  1. Chest XRay
    1. Pulmonary edema
    2. Cardiomegaly
  2. Bedside Echocardiogram
    1. Decreased cardiac contractility
    2. Cardiac Tamponade

VIII. Diagnostics

  1. Electrocardiogram (EKG)

IX. Differential Diagnosis

  1. Neonatal Sepsis
  2. Congenital metabolic conditions
  3. Acute Respiratory Distress Syndrome

X. Management

  1. Initiate transport to pediatric ICU facility with ECMO capability
  2. Immediate pediatric Consultation
  3. Oxygen
    1. High Flow Oxygen indicated in most patients
    2. Do not increase FiO2 in hypertrophic left heart
      1. Keep the ductus arteriosus patent
  4. Endotracheal Intubation
    1. Early intubation for increasing respiratory distress
  5. Inotrope support (consult pediatric intensivist)
    1. Dopamine
    2. Dobutamine
    3. Milrinone
  6. Diuretic (if volume overloaded)
    1. Furosemide 1-2 mg/kg IV
  7. Analgesia and sedation
    1. Sedation with Morphine Sulfate 0.05 to 0.1 mg/kg IV
  8. Fluid maintenance
    1. Fluids to 66% of expected fluid maintenance requirement

XI. References

  1. Herndon (2003) AAFP Board Review, Seattle
  2. Claudius, Behar, Salway and Kearl in Herbert (2018) EM:Rap 18(5): 1-3

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term “Pediatric Congestive Heart Failure.” Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

BÀI LIÊN QUAN