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Pediatric Heart Failure: Principles for Primary Care

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1 Pediatric Heart Failure: Principles for Primary Care
Presented by Tricia Brown, MSN, APRN, CPNP, CCRN

2 No disclosures.

3 CONGENITAL HEART DISEASE

4 What is Pediatric Heart Failure?

5 What is Pediatric Heart Failure?

6 What is Pediatric Heart Failure?

7 Causes of Heart Failure
Infancy Congenital heart disease Childhood Cardiomypathy Acquired disease: myocarditis, Kawasaki disease Adolescence Acquired disease: myocarditis Palliated congenital heart disease

8 “Enlarged Heart” Disease
Cardio My What? “Enlarged Heart” Disease

9

10 Myo Huh?

11 Myo Huh?

12 Medical Therapies

13 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

14 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

15 Medical Therapies Enalapril Classification: antihypertensive
Therapeutic effects: decrease afterload Side Effects: Orthostatic hypotension, dizziness Hyperkalemia Renal dysfunction Cough Adverse reaction: angioedema Counseling: Good hydration

16 Beta Blocker: Carvedilol

17 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

18 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

19 Medical Therapies spironolactone (Aldactone)
Classification: aldosterone antagonist Therapeutic effects: anti-fibrotic Side Effects: Hyperkalemia Gynecomastia

20 Diuretics Loop-diuretics Lasix, Bumex Thiazide diuretic Diuril
Low cardiac output, Elevated pressures Congestion Fluid Retention Loop-diuretics Lasix, Bumex Thiazide diuretic Diuril

21 Medical Therapies Diuretics Therapeutic effects: fluid removal
Side Effects: Electrolyte derangement Dehydration Renal impairment

22 Care of the Child with Complex Heart Disease

23 Care of the Child with Complex Heart Disease
They get common childhood illnesses. Prescribe antibiotics judiciously.

24 Care of the Child with Complex Heart Disease
Fontan Physiology: The Blood Goes Where?

25 Care of the Child with Complex Heart Disease
Fontan Physiology: Is there a hole or no?

26 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

27 When in doubt, call!

28 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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