Heart failure

Published on 23/06/2015 by admin

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Last modified 23/06/2015

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5.2 Heart failure

1 Congestive heart failure (CHF) is a clinical syndrome and may result from:

• excessive workload caused by increased pressure or volume, usually increased pulmonary blood flow, and/or

• normal workload faced by a damaged myocardium.

2 Clinical signs may include tachycardia, tachypnoea, increased work of breathing, sweatiness, cardiomegaly and hepatomegaly. In addition, infants may have failure to thrive, recurrent lower respiratory tract infections and respiratory distress.

3 In older children, new onset heart failure may be less overtly symptomatic. Malaise, decrease in the level of daily activity, abdominal pain, nausea, anorexia and weight loss may be present.

4 Current medications used in heart failure include diuretics, digoxin and angiotensin-converting enzyme inhibitors.

Causes of congestive heart failure ¹^–⁴

Most cases of congestive heart failure in childhood result from congenital heart defects.

Left-to-right shunts with increased pulmonary blood flow, e.g. ventricular septal defect (VSD), atrioventricular septal defect (AVSD), patent ductus arteriosus (PDA). atrioventricular septal defect, patent ductus arteriosus.

Acute left heart obstruction, e.g. aortic stenosis, coarctation of the aorta, interrupted aortic arch, hypoplastic left heart syndrome.

A smaller number of cases may be from:

Primary myocardial dysfunction, e.g. myocarditis, cardiomyopathy, anomalous left coronary artery.

Other causes, e.g. anaemia, metabolic, toxic, dysrhythmia.

Age-based

The causes of congestive heart failure change with age. Congenital heart defects generally present in the first days or months of life. Acquired cardiac disease may occur at any age. The following lists the likely causes at particular ages.

First days of life

Asphyxia, left heart obstruction, metabolic, sepsis.

One day to one week of age

Left heart obstruction in duct-dependent lesions, e.g. aortic stenosis, coarctation of the aorta.

Large left-to-right shunt lesions, e.g. large VSD, AVSD, truncus arteriosus.

First month

Large left-to-right shunt, e.g. large VSD, AVSD, truncus arteriosus.

First three months

Large left-to-right shunt, e.g. large VSD, AVSD, truncus arteriosus.

Metabolic disease.

Acquired heart disease may occur at any age due to:

• inflammatory/infective, e.g. viral myocarditis, Kawasaki disease, pleuropericarditis, rheumatic fever;

• metabolic genetic, e.g. inherited cardiomyopathy;

• dysrhythmia, e.g. sustained SVT, ventricular tachycardia (VT);

• severe anaemia.

Clinical manifestations and investigations ¹^–⁴

Presentation

Infants may present with problems related to feeding, such as sweating, tachypnoea, reduced volume of feeds leading to failure to thrive. Respiratory problems, such as cough, recurrent respiratory infections, tachypnoea and increased work of breathing are prominent. Lower respiratory tract infection may have features in common with congestive cardiac failure (CCF). Cardiac failure should be considered in atypical, persistent or recurrent cases of lower respiratory tract infection (LRTI), particularly in infants.

General features

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Textbook of Paediatric Emergency Medicine