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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