Pediatric congestive heart failure case study
An increase in heart rate is the dominant mechanism to increase cardiac output in all patients with heart failure, but this is especially important in infants and younger children. In contrast to heart failure in adults, pediatric patients often have normal left ventricular function.
As a complex clinical syndrome, HF is characterized by typical symptoms and signs associated with specific circulatory, neurohormonal, and molecular abnormalities. Diagnosis There are no definitive tests for myocarditis or cardiomyopathy.
Initial testing should include an ECG, chest radiograph, and cardiac enzymes once heart failure is suspected [ 8 ]. A 12 lead electrocardiogram shows a sinus tachycardia, normal PR and QTc intervals, and a left axis deviation.
Pediatric congenital heart failure
His examination was notable for quiet heart sounds a possible holosystolic murmur and a quiet gallop. Rheumatologic studies were sent and were significant for low complement levels. The global burden of HF is unknown as too many children have no access to medical care and die of HF each year. Follow-up in cardiology clinic revealed a normal exam, return to baseline behavior, and normal echocardiogram. Cardiac beta-receptors are down-regulated causing a reduced inotropic response to beta-adrenergic stimulation. It is often difficult to make the diagnosis of heart failure if failure is not consciously considered as a possibility. Diagnosis There are no definitive tests for myocarditis or cardiomyopathy. Alterations in calcium handling occur within the myocardium secondary to impairment of sarcoplasmic reticulum function, anaerobic metabolism, and developing acidosis. Younger children may present with non-specific malaise or decreased energy, as are often seen with viral illnesses, sometimes associated vomiting is the primary symptom concerning the parents [ 7 ]. She continues to have poor weight gain on higher caloric density formula and continues to have symptoms of heart failure on medical management.
Despite slow improvement in cardiac enzyme studies, the patient continued to require increasing amounts of milrinone and diuretic therapy. Venous congestion due to a failing heart can not only cause pulmonary edema, but also lead to hepatomegaly.
The fall in cardiac output and changes in regional circulation accompanying heart failure leads to an activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system.
Digoxin for pediatric heart failure
Their role in the treatment of heart failure in children is less well defined. The other main cause of pediatric HF is cardiomyopathy predominantly dilated cardiomyopathy , with an estimated annual incidence of 1 per , children in the US, Australia, United Kingdom UK , and Ireland [ 11 , 12 , 13 ]. The most important parameter to increase to reverse pulmonary edema is the PEEP, which is the positive end-expiratory pressure. Older patients may complain of shortness of breath, fatigue, or wheezing, making the presentation difficult to distinguish from asthma exacerbations [ 6 ]. Her parents reported that she had three episodes of non-bloody, non-bilious emesis over 1 day and seemed fatigued. Tachycardia is commonly seen and usually relates to fever, fear, or a pulmonary problem. Abstract Pediatric heart failure HF represents an important cause of morbidity and mortality in childhood. Several studies have shown a reduction in both hospitalization and mortality. Her skin is clear with no rashes or other significant skin lesions. Her parents have also noted her to be increasingly lethargic, with tachypnea, and retractions. She continues to have poor weight gain on higher caloric density formula and continues to have symptoms of heart failure on medical management. The S1 is normal and the S2 is prominent. Bowel sounds are hypoactive.
Younger children may present with non-specific malaise or decreased energy, as are often seen with viral illnesses, sometimes associated vomiting is the primary symptom concerning the parents [ 7 ].
based on 90 review