Dr Satti Abdelrahim Satti Pediatric Consultant بسم الله الرحمن الرحيم Heart Failure Dr Satti Abdelrahim Satti Pediatric Consultant 4/27/2019

Introduction 4/27/2019

Congestive Heart Failure 4/27/2019

!! Congestive heart failure occurs when the heart can no longer meet the metabolic demands of the body at normal physiologic venous pressures. 4/27/2019

!! Congestive heart failure in the fetus, or hydrops, can be detected by performing fetal echocardiography. !! Due to underlying anemia, arrhythmias ( supraventricular tachycardia), myocarditis or cardiomyopathy. 4/27/2019

!! Neonates and infants younger than age 2 months are the most likely group to present with congestive heart failure related to structural heart disease. !! Myocardial disease due to primary myopathic abnormalities or inborn errors of metabolism must be investigated. 4/27/2019

!! Respiratory illnesses, anemia, and known or suspected infection must be considered. !! Renal failure can result in CHF due to fluid retention and anemia. 4/27/2019

!! In older children, is caused by valvar or subvalvar aortic stenosis, coarctation, myocarditis, cardiomyopathy, hypertension, renal failure, arrhythmias or myocardial ischemia. 4/27/2019

Physical Examination !! Low cardiac output with hypotension !! Cool extremities & poor peripheral perfusion. !! Thready pulse . !! Decreased urine output. 4/27/2019

Tachycardia. Venous congestion : !! Tachycardia . !! Venous congestion : * Right-sided (hepatomegaly, ascites, abdominal pain, pleural effusion, edema, jugular venous distention) * Left-sided (tachypnea, retractions, nasal flaring or grunting, rales, pulmonary edema) 4/27/2019

!! Low cardiac output : Fatigue or low energy, pallor, sweating, cool extremities, nausea / vomiting, poor growth, dizziness, altered consciousness, and syncope 4/27/2019

Treatment & Management !! The goals of medical therapy include the following: Reducing the preload. Enhancing cardiac contractility. Reducing the afterload. Improving oxygen delivery. Enhancing nutrition. As 4/27/2019

Oral (PO) or IV diuretics eg, Furosemide, Thiazides or Metolazone !! Oral (PO) or IV diuretics eg, Furosemide, Thiazides or Metolazone. !! Dopamine, Dobutamine, Inamrinone or Milrinone. !! Digoxin appears to have some benefit 4/27/2019

Angiotensin-converting enzyme (ACE) inhibitors e g Captopril !! Angiotensin-converting enzyme (ACE) inhibitors e g Captopril !! Serum potassium levels may be monitored, and supplementation should be provided 4/27/2019

!! Enhanced caloric content feedings and, in some cases, nasogastric or gastrostomy feedings may be necessary to maintain the patient's growth. 4/27/2019

!! Cardiac resynchronization therapy (CRT) has emerged as a useful therapy in the treatment. !! CRT involves use of biventricular pacemakers to improve ventricular function by electrically adjusting the timing of right & left ventricular contraction. 4/27/2019

Thank You 4/27/2019