heart failure in children and pediatrics)

heart failure in pediatrics

1. Heart Failure in Children Definition, Types , Patho - physiology , Etiology, Clinical Features, Complications, Management Progn osis Prof. Imran Iqbal Fellowship in Pediatric Neurology (Australia) Prof of Paediatrics (2003-2018) Prof of Pediatrics Emeritus, CHICH Prof of Pediatrics, CIMS Multan, Pakistan

2. On the day of judgement, wealth or family will not be of any benefit; only the person who comes with a pure heart will be successful Al Quran surah Al Shuaraa 26:88-89

3. He art • Human heart beats 115,000 times each day • Human Heart pumps 7500 liters of blood in 24 hours • Human Heart supplies nutrients to each cell of the body through blood vessels which are 100,000 km long

4. Cardiac Failure • Definition: Failure of cardiac output to meet metabolic needs of the body • Cardiac Failure results in inadequate oxygen delivery to body tissues • Compensated Heart Failure: compensatory mechanisms increase the cardiac output and the oxygen delivery • Decompensated Heart Failure: compensatory mechanisms start failing and cardiac output starts falling

5. Cardiac Output • Cardiac Output = Heart Rate X Stroke Volume • Stroke volume is dependent on three factors: • • Preload - (blood volume overload, End Diastolic Volume) • • Afterload - resistance (pressure) against which the heart must pump blood, systemic vascular resistance • • Contractility of heart - Cardiac Performance

6. Volume overload increases contractility of Heart

7. Compensatory Mechanisms in Heart Failure

8. Types of Heart Failure • Compensated Heart Failure – • compensatory mechanisms are successful - increased heart rate and force of contraction (chronotropic and ionotropic effect) - stroke volume increased - cardiac output maintained • Decompensated Heart Failure – • compensatory mechanisms fail - cardiac contractility low - cardiac output decreased - venous congestion - edema

9. Decompensated Heart Failure

10. Pat hology • Cardiac Hypertrophy • Pulmonary edema • Venous congestion • Dependent edema (pitting edema)

11. Eti ology • Volume overload - L to R shunts in heart, Fluid overload, Severe anemia • Decreased Contractility - Myocarditis, Cardiomyopathy, Hypoxia, Hemosiderosis • Pressure overload – Systemic Hypertension, Pulmonary Hypertension ( cor - pulmonale ) • Diastolic Dysfunction – Pericardial effusion

12. Heart Failure in Children • Congenital Heart Disease – VSD, ASD, PDA • Rheumatic Fever, Rheumatic Heart Disease - MR • Cardiac Arrhythmia - SVT, VT • Severe anemia • Pericardial effusion • Hypertension – Renal diseases (Acute glomerulonephritis, CK D) • Pulmonary hypertension (cor-pulmonale) • Cardiomyopathy

13. Clinical Features

14. Clinical Scenario • A 3 months old baby presents to the OPD with complaints of frequent cough and cold for the last 2 months. • Baby is on mother feeding, but takes feeding for a short time only. He remains fussy and cries often • Weight of the infant is 4 kg. • On examination, his heart rate is 150/min and respiration is 60/m in. • Chest examination: apex beat at 5 th intercostal space 1 cm left to mid-clavicular line. A pan-systolic murmur is audible at left lower sternal border. • Abdominal examination shows enlarged liver palpable by 4 cm below the right costal margin • What is your diagnosis ?

15. Sympt oms • Infants : • Feeding problems, sweating • Oliguria • Growth failure • Older children: • Exertional dyspnea • Fatigue • Edema • Palpitation • Pain abdomen

16. Sig ns • Tachycardia (fast heart rate) • Tachypnea (fast breathing ) • Cardiomegaly (shifted apex) • Hepatomegaly • JVP raised • Edema – pulmonary, systemic • Growth failure

17. D iagnosis • X – ray Chest (cardiomegaly) • ECG – (ventricle hypertrophy) • Echocardiography – • Low Ejection Fraction (N = 55-65%) • Oxygen saturation (Pulse oximetry) – low in pulmonary edema

18. Other Investigations • CBC • Electrolytes • Cardiac Biomarkers – increase in ventricular dilation - Brain natriuretic peptide (BNP) - more than 100 pg/mL - N -terminal prohormone BNP (NT-pro BNP) • Liver Function Tests • Renal Function Tests

19. Com plications • Cardiac Arrhythmia • Thrombo - embolism • Repeated chest infections • Pulmonary edema • Liver dysfunction • Renal failure • Electrolyte Imbalance • Failure to thrive – low weight and height

20. Manag ement

21. Supportive Management • Comfortable environment • Rest • Position • Feeding • Fluid restriction • Anemia – iron supplements • Blood transfusion

22. Specific Management • Diuretics • Digoxin • ACE inhibitors (ACEI, ARB) • Neprilysin inhibitors • Beta-blockers • Treat the cause of Heart Failure

23. Prog nosis • Etiology of HF • Severity of HF • Response to treatment

24. Clinical Assessment of Severity in Adults

25. Clinical Assessment of Severity in Children

26. Medical Profession