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Pediatric Heart Failure: Principles for Primary Care
Presented by Tricia Brown, MSN, APRN, CPNP, CCRN
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No disclosures.
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CONGENITAL HEART DISEASE
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What is Pediatric Heart Failure?
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What is Pediatric Heart Failure?
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What is Pediatric Heart Failure?
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Causes of Heart Failure
Infancy Congenital heart disease Childhood Cardiomypathy Acquired disease: myocarditis, Kawasaki disease Adolescence Acquired disease: myocarditis Palliated congenital heart disease
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“Enlarged Heart” Disease
Cardio My What? “Enlarged Heart” Disease
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Myo Huh?
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Myo Huh?
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Medical Therapies
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Renin-Angiotensin-Aldosterone System
Fibrosis Blood Pressure Salt Retention Inflammation Vasoconstriction Bradykinins & nitric oxide Aldosterone Angiotensin II Salt Retention Angiotensin converting enzyme LV Remodeling Salt Retention Angiotensin I Renin Angiotensinogen (from the liver) Blood Pressure
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ACE Inhibitor: Enalapril
Fibrosis Blood Pressure Salt Retention Inflammation Vasoconstriction Bradykinins & nitric oxide Aldosterone Angiotensin II Salt Retention Angiotensin converting enzyme LV Remodeling Salt Retention Angiotensin I Enalapril Renin Angiotensinogen (from the liver) Blood Pressure
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Medical Therapies Enalapril Classification: antihypertensive
Therapeutic effects: decrease afterload Side Effects: Orthostatic hypotension, dizziness Hyperkalemia Renal dysfunction Cough Adverse reaction: angioedema Counseling: Good hydration
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Beta Blocker: Carvedilol
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Medical Therapies Carvedilol
Classification: nonselective beta blocker, antihypertensive Therapeutic effects: block CNS activation Side Effects: Hypotension Bradycardia Adverse effect: exacerbation of heart failure with initiation and up-titration Counseling: Good hydration
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Medical Therapies digoxin Classification: cardiac glycoside
Therapeutic effects: Increase intracellular calcium within the myocardium – increased contraction Side Effects: Hyperkalemia Bradycardia Adverse Effects Arrhythmias, including heart block Toxicity: GI symptoms, vision disturbances
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Medical Therapies spironolactone (Aldactone)
Classification: aldosterone antagonist Therapeutic effects: anti-fibrotic Side Effects: Hyperkalemia Gynecomastia
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Diuretics Loop-diuretics Lasix, Bumex Thiazide diuretic Diuril
Low cardiac output, Elevated pressures Congestion Fluid Retention Loop-diuretics Lasix, Bumex Thiazide diuretic Diuril
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Medical Therapies Diuretics Therapeutic effects: fluid removal
Side Effects: Electrolyte derangement Dehydration Renal impairment
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Care of the Child with Complex Heart Disease
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Care of the Child with Complex Heart Disease
They get common childhood illnesses. Prescribe antibiotics judiciously.
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Care of the Child with Complex Heart Disease
Fontan Physiology: The Blood Goes Where?
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Care of the Child with Complex Heart Disease
Fontan Physiology: Is there a hole or no?
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Care of the Child with Complex Heart Disease
Fontan Physioogy: Unique Complications Protein Losing Enteropathy C/O diarrhea, malodorous Plastic Bronchitis C/O productive cough – white casts, rubbery, branch-like Wheezing not improved with albuterol Heart Failure
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When in doubt, call!
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References Canter, CE & Simpson, KE. Diagnosis and treatment of myocarditis in children in the current era. Circulation. 2014, 129: Hollander, SA, et al. Abdominal complaints as a common first presentation of heart failure in adolescent dilated cardiomyopathy. Am J of Emerg Med. 2013, 31: Kantor, P., et al. Presentation, diagnosis, and medical management of heart failure in children: Canadian cardiovascular guidelines. Canadian Journal of Cardiology. 2013, 29 (12); Park, MY. Park’s Pediatric Cardiology for Practitioners. 6th Ed Tsu, DT, & Canter, CE. Dilated cardiomyopathy and heart failure in children. Heart Failure Clin. 2010, 6: Tsu, DT, & Pearson, GT. Heart failure in children part I: History, etiology, and pathophysiology. Circ Heart Fail. 2009, 2: Tsu, DT, & Pearson, GT. Heart failure in children part II: Diagnosis, treatment, and future directions. Circ Heart Fail. 2009, 2: Wolters Kluwer Clinical Drug Information, Inc. Lexicomp. 2017, version: 3.0.1
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