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Congestive Heart Failure in Children PowerPoint Presentation

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Description : Check out this medical presentation on Congestive Heart Failure, which is titled "Congestive Heart Failure in Children", to know about Congestive Heart Failure in Children, its causes and treatment.

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Published on : Jul 01, 2021 | Views : 3183 | Downloads : 3

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Congestive Heart Failure in Children Thomas R. Burklow, MD LTC, MC Asst C., Pediatric Cardiology
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Odenwald mountains
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Case Presentation 4 month old presents to ER with cc: “cold sx” 5 day history of increasing cough; afebrile, no rhinorrhea, no ill contacts. PMH: unremarkable. vigorous feeder (25-30oz/d) until the last couple of days. FHx: father had a “leaky valve” but was cleared to join the Marines
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Physical Examination VS: HR 165, RR 60, Nl BPs throughout; RA O2 sat mid 80’s, increases to 97% on 1/4 L/ O2 Small for age male, nondysmorphic, mild cyanosis, moderate increased work of breathing Left chest prominent Prominent PMI, RRR, S2 obscured by murmur, gr III pansystolic SRM over apex to left axilla Liver edge 4 cm below RCM 1+ pulses throughout
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Electrocardiogram
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Chest X ray
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Neckargemund
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Cause of Congestive Heart Failure Excessive work load: pressure or volume Normal workload faced by a damaged myocardium
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Etiologies Neonate dysfunction volume pressure Infant Volume Dysfunction Child Palliated congenital heart disease AV valve regurgitation Acute rheumatic fever Myocarditis Endocarditis
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Clinical manifestations Infant feeding difficulties failure to thrive diaphoresis tachycardia tachypnea Child breathlessness tachycardia tachypnea peripheral edema cardiomegaly
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Treatment Digitalis oral: 8-10 mcg/kg/day I.V.: 80% of oral dose Because of varying metabolism, appropriate dose varies by age Rapid digitalization May be performed over 12-24 hours, 6-12 hours in dire situations Calculate TDD (varies by age); administer 1/2 of TDD, followed by 1/4, then 1/4 of TDD Case example: patient weight is 5.5 kg
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Effiel Tower at Dusk
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Case example 5.5 kg in a 4 month old Oral TDD for 1 month-2 years is 30-50 mcg/kg TDD is 220 mcg Administer 110 mcg now, then 55 mcg in 12 hours, then 55 mcg in 6 hours IV dose is 80% of the above amounts Maintenance digoxin is approximately 1/4 of TDD, divided b.i.d., or at 50 mcg/cc, 0.1 cc/kg per dose b.i.d.
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Digoxin toxicity Levels are helpful only in cases of suspected toxicity, not for management GI symptoms are common presenting symptoms: nausea, vomiting, anorexia Most common sign of cardiac toxicity is arrhythmia: bradycardia, AV block, PVCs Treatment includes holding doses for 1-2 half lives, atropine for sinus bradycardia, and “FAB” fragments in cases of significant toxicity
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Nutrition What are maintenance calories for a normal infant? What is the metabolic state of an infant in congestive heart failure? What are the caloric requirements for an infant in congestive heart failure?
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Other medications Diuretics Furosemide (Lasix); 0.5-1.0 mg/kg/dose Chlorothiazide (Diuril); 20-50 mg/kg/day Spironolactone (Aldactone); 1-2 mg/kg/day Afterload reduction Captopril (Capoten); 0.1-0.5 mg/kg/dose t.i.d. Enalapril (Vasotec); 0.1 mg/kg/day Beta-blocker Labetolol
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Elliott!!!