Post on 14-Sep-2015
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Congestive Cardiac Failure
A. Congestive Cardiac Failure
Def.: Inability to maintain an output necessary formetabolic needs of the body (systolic failure) andinability to receive blood into ventricular cavities. At lowpressure during diastole (Diastolic Failure)
Causes Of Diastolic Failure:
1. Mitral or tricuspid stenosis
2. Constrictive pericarditis
3. Restrictive cardiomyopathy
Miscellaneous causes of 'CHF in infancy:
1. Infections
2. Hypoglycemia
3. Hypocalcemia
4. Neonatal asphyxia
Time of onset of chf in congenital lesions
Age LesionBirth to 72 hrs Pulmonary, mitral & aortic
atresias4 days to I week Hypoplastic left heart, TGA1 to 4 weeks"
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Endocardial fibroelastosis,Coarctation of the aortatransposition complexes
1-2 months Endocardial cushiondefects. VSD. PDA, TAPVCAnomalous left coronaryartery
Table: Symptoms of congestive cardiac failure
i. Poor weight gain
ii. Difficulty in feeding
iii. Breathes too fast; breathes better when heldagainst the shoulder
iv. Persistent cough and wheezing
v. Irritability, excessive perspiration andrestlessness
vi. Pedal edema
Table: Signs of congestive cardiac failure in infantsLeft-sided
failureFailure of either
sideRight-sided
failureTachypnea Cardiac
enlargementHepatomegaly
Tachycardia Gallop rhythm(s3)
Facial edema
Cough Peripheralcyanosis
Jugular venous
Wheezing Small volumepulse
Engorgement
Rales in chest Absence ofweight gain
Edema on feet
Myocardial diseases as a cause of CHF:
The commonest cause of myocarditis is Coxsackie B**infection
Primary myocardial diseases causing CCF:
a. Glycogen storage disease
b. Endocardial fibroelastosis
c. Medial necrosis of coronary arteries
Stepwise management of CHF:
a. Step 1Frusemide with amiloride ortriamterene
b. Step 2Digoxin
c. Step 3ACE inhibitors and stop potassiumsparing diuretics
d. Step 4isosorbide nitrate
e. Step 5Dobutamine/dopamine
f. Step 6Myocardial biopsy and addimmunosuppressive with steroids
g. Step 7 - cardiac transplantation
Digoxin
a. Augments cardiac contractility (Positiveionotropic)
b. Total digitalizing dose- 0.04 mg/kg (o.06 1-3yrs)
c. 1st dose - /
d. 2nd dose / after 8 hrs
e. 3rd / after another 8 hrs
f. Parenteral dose 7/10 or 2/3 of the oral
g. Toxicities-vomiting, X 1.5 pr interval of baseline.
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