Congestive Heart Failure
Pathophysiology
- Preload (diastolic loading of the ventricles)
- Afterload (systolic loading of the ventricles)
- Cardiac contractility
- Heart rate
- 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)
Aetiology
- Volume Overload
- Left to right shunt (VSD,PDA)
- Anemia
- Pressure Overload
- LV outflow obstruction (AS, coarctation)
- Myocardial Dysfunction
- Dysrhythmia
- Infection
- Autoimmune (SLE, ARF)
- Poisoning (TCA, digitalis)
Failure
| Condition | Presentation |
|---|---|
| Hypoplastic left heart | Week 1 |
| Coarctation of the aorta | Week 1 |
| Complete AV canal | Week 2 |
| PDA | Week 2 |
VSD |
Week 4 |
Cyanosis (unresponsive)
| Condition | Presentation |
|---|---|
| Transposition | Week 1 |
| TAPVR | Week 1 |
| Ebstein's anomaly | Week 2 |
| Pulmonary stenodis | Week 2 |
Tertalony of Fallot |
Week 4 |
Symptoms / signs of CCF
- Poor feeding, (plus increased resp work)
- FTT
- Sweating
- LRTIs
- Pallor & tachypnoea
- Tachycardia (gallop), cardiomegaly
- Hepatomegaly and oedema late
- Shock (long CRT, col dperipheries - 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)
