Heart Failure in Children Overview

Study Notes

Heart failure: Inability of the heart to provide sufficient cardiac output for the body's metabolic needs.
Symptoms in children: Include fatigue, effort intolerance, anorexia, abdominal pain, dyspnea, and cough. Older children may primarily exhibit abdominal symptoms.

Common signs: Orthopnea, basilar rales, edema, cardiomegaly, gallop rhythm, and holosystolic murmur from mitral/tricuspid valve regurgitation.
Infants may show: Tachypnea, feeding difficulties, poor weight gain, irritability, weak cry, and labored breathing with intercostal/subcostal retractions.
Distinguishing features: Cardiac-induced pulmonary congestion may mimic bronchiolitis; wheezing is often present.

Fetal factors: Severe anemia, supraventricular tachycardia (SVT), ventricular tachycardia (VT), complete heart block.
Premature neonates: Fluid overload, patent ductus arteriosus (PDA), ventricular septal defect (VSD), cor pulmonale.
Full-term neonates: Asphyxial cardiomyopathy, arteriovenous malformations, left-sided obstructive lesions, viral myocarditis.
Infant to toddler: Left-to-right shunts (e.g., VSD), metabolic cardiomyopathy, Kawasaki disease.
Child to adolescent: Rheumatic fever, viral myocarditis, cardiomyopathy, and cancer therapy side effects.

Chest X-Ray (CXR): Reveals cardiac enlargement and pulmonary vessel congestion, indicating heart failure severity.
Electrocardiogram (ECG): Assesses for chamber hypertrophy and rhythm disorders.
Echocardiogram: Evaluates fractional shortening; normal ranges from 28-40%. Ejection fraction normal is 55-65%.

Treat underlying causes of heart failure.
General measures: Adequate rest and possibly a semi-upright sleeping position for older patients. Consider infant chairs for infants.
Diet: Higher calorie formulas for infants, with cautious moderation to avoid gastrointestinal distress. Nasogastric feedings may be necessary for severely ill infants.

Digitalis (Digoxin): Commonly used in pediatrics; effective within 30 minutes orally, 15-30 minutes intravenously. Dosages vary significantly based on age and condition.
- Toxicity risks: Hypokalemia, hypercalcemia, and various arrhythmias require careful monitoring.
Diuretics: Reduce fluid overload and blood volume. Furosemide is preferred, with potassium supplementation often required. Spironolactone may be used to increase potassium retention.
Afterload-reducing agents: ACE inhibitors like captopril and enalapril lower blood pressure, reduce afterload, and have beneficial effects on cardiac structure.

Close ECG monitoring during digoxin therapy to detect rhythm disturbances.
Maintain potassium levels in patients on diuretics to prevent toxicity.
Dosage adjustments for digitalis therapies should consider clinical status and prior responses.