1. Heart Failure Dr Elspeth Brown Consultant Paediatric Cardiologist
Lead for Congenital Cardiac Network
Nurses study day oct 2018

3. Heart Failure: Presentation
Clinical diagnosis characterised by
Tachycardia
Tachypnoea
Increased work of breathing
Enlarged liver
If chronic may be FTT
If acute may be collapse

4. Cardiac Causes
Left to right shunt eg VSD, PDA, Complex with unrestricted pulmonary blood flow
Valvar regurgitation – particularly mitral or aortic
(Neonates: duct dependant lesions)
Poor left ventricular function

5. None cardiac causes
High output failure eg Vein of Galen, AVMs, thyrotoxicosis
Septic shock

6. Cardiac causes
Increased left atrial pressure leading to pulmonary venous hypertension and pulmonary oedema
Decreased systemic cardiac output

7. VSD
DCM

8. Stepwise approach Medical Treatment Diuretics ACE inhibitors
Nutrition support
Respiratory support
Intervention
Surgery
Catheter

9. 4.Patent ductus arteriosus (PDA)

10. PDA

11. DRUGS
Diuretics
Furosemide – loop diuretic leading to block of re-uptake of sodium, potassium and chloride in distal loop of Henle so water follows
Spironolactone – aldosterone antagonist enhances re-uptake of potassium

12. ACE inhibitors
Diuretics lead to activation of renin/angiotensin system so stop working
Addition of ACE inhibitor helps that and drops systemic vascular resistance.

13. 1. Ventricular Septal Defects - VSD
Doubly committed
5 % European, 30 % Asian
Peri-membranous %
Muscular
20%
Inlet
AVSD spectrum

14. VSD

15. Oxygen Caution: If LV pump failure, O2 helps
If left to right shunt, may make worse by decreasing PVR and increasing shunt

16. Nutrition, vapotherm, NJ feeds

17. Nutrition
Heart failure leads to increased metabolic demands and may delay gastric emptying so small volume bolus or continuous tube feeding
NJ feeding if vomiting
Maximise calorie intake as some conditions improve with growth eg PDA, VSD
High calorie feeds

18. Respiratory support
Positive pressure eg vapotherm helpful if very breathless
Use of oxygen depends on underlying condition since will act as pulmonary vasodilator which may exacerbate shunt
Care when intubating patient with poor function as induction drugs may lead to cardiac arrest

19. Specific Treatments Repair defect may be surgery or catheter
Palliate defect eg PA band
Valvar regurgitation may be more difficult to deal with, especially in very young baby/child

20. Summary Common clinical picture with different aetiology
Common treatment then specific disease related treatment
Each case individual

21. Stepwise approach Medical Treatment Diuretics ACE inhibitors
Nutrition support
Respiratory support
Intervention
Surgery
Catheter