12 Questions
What is the definition of congestive heart failure?
The pathophysiologic state in which the heart is unable to pump blood at a rate commensurate with the body's metabolic needs
What are the three factors that determine stroke volume?
Preload, afterload, and contractility
What is the main cause of congestive heart failure in a child under 1 year old?
Congenital heart disorder
What is the main cause of congestive heart failure in a child over 1 year old with no congenital anomaly?
Acquired heart disease
Which of the following is not a symptom of systemic venous congestion in congestive heart failure?
Tachypnea
What is the main mechanism by which the heart is unable to maintain adequate cardiac output in congestive heart failure?
Combination of inability to dispose systemic and pulmonary venous return adequately
What is a common presenting symptom of heart failure in neonates and infants?
Poor feeding
Which diagnostic tool is used to assess heart chamber sizes and myocardial function accurately?
Echocardiogram
What is the main function of Digitalis in the treatment of heart failure?
Improving cardiac contractility
Which of the following is NOT a part of the '4D's' approach to treating heart failure?
Diet modification
What does Furosemide (Lasix) do in the treatment of heart failure?
Acting as a diuretic
When should an apical pulse be taken in relation to the administration of Digoxin?
1 full minute before administration
Study Notes
Congestive Heart Failure (CHF)
- Defined as a pathophysiologic state in which the heart is unable to pump blood at a rate commensurate with the body's metabolic needs.
- Inability to dispose of systemic or pulmonary venous return adequately, or a combination of both.
- Characterized by the heart's inability to maintain an adequate cardiac output.
Factors Affecting Cardiac Output
- Preload: volume of blood in the ventricle at the end of diastole.
- Afterload: pressure required to push blood into the arteries.
- Contractility: ventricles' ability to squeeze.
Clinical Manifestations
- Systemic Venous Congestion:
- Weight gain
- Hepatomegaly
- Edema
- Jugular vein distention
- Pulmonary Venous Congestion:
- Tachypnea
- Dyspnea
- Cough
- Wheezes
Compensatory Response
- Tachycardia
- Cardiomegaly
- Diaphoretic
- Fatigue
- Failure to grow
Assessment
- Clinical history:
- Neonates and infants: poor feeding, tachypnea, cold sweat on forehead, poor weight gain
- Older children: fatigue, exercise intolerance, dyspnea, puffy eyes and pedal edema, growth failure
Diagnostics
- Chest x-ray:
- Cardiomegaly
- Pulmonary edema
- ECG:
- Arrhythmias
- Echocardiogram:
- Assesses heart chamber sizes, measures myocardial function accurately, diagnoses congenital heart defects
- Pulse-oximetry, CBG, hyperoxia test, CBC, U&A, calcium, creatinine, LFT, thyroid function
Treatment
- Correct underlying causes of HF
- The 4D's:
- Diet (low salt, high calories)
- Digitalis (improves cardiac contractility)
- Diuretics (reduces preload)
- Dilators (reduces afterload)
- General Care:
- Rest
- Oxygenation
- Small frequent feeding
- Diet modification (sodium and fluid restriction)
- Treatment of underlying cause:
- Repair of congenital defects (VSD, ASD)
- Heart transplantation
Medications
- Diuretics:
- Furosemide (Lasix)
- Spironolactone/Aldactone
- Digitalis:
- Digoxin
- Dilators:
- ACE
- Hydralazine
- Nitroprusside
- Captopril
Digoxin Therapy
- Increases the force of the myocardial contraction
- Take an apical pulse with steth for 1 full min before every dose of digoxin
- If bradycardia is detected, withhold digoxin dose
This quiz covers the pathophysiology of congestive heart failure, focusing on the heart's inability to pump blood adequately. It discusses the differences in causes between individuals under 1 year old with congenital disorders and those over 1 year old with acquired heart disease.
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