Download Free Medical Heart Failure in pediatrics PowerPoint Presentation

Heart Failure in pediatrics PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Pediatrics, which is titled "Heart Failure in pediatrics", to know about Heart Failure in pediatrics.

Tags : Pediatrics, Heart Failure

Published on : Aug 02, 2021 | Views : 1810 | Downloads : 7

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Heart Failure in pediatrics Investigations & Treatment Jenan muhammed 8th term ESIC MC PGIMSR
Slide 2-

Chest radiography High specifity and negative predictive value Cardiomegaly- suggestive of ventricular dilatation or hypertrophy Large right to left shunts-exaggerated pulmonary arterial vessels marking towards periphery Cardiomyopathy- lung fields normal Severe HF- fluffy perihilar pulmonary markings suggestive of pulmonary edema
Slide 3-

ppt slide no 3 content not found
Slide 4-

Laboratory investigations Symptomatic HF- associated with perturbations of electrolyte and fluid balance, renal function, liver function, thyroid function Hyponatremia due to renal water retention (chronic Diuretic treatment still worsens tht)
Slide 5-

ECG Nonspecific but frequently abnormal in pediatric HF patients With findings of LV hypertrophy, low voltage QRS morphology with ST-T wave abnormalities (myocardial inflammatory disz,also pericarditis), MI patterns, AV blocks, Best tool for evaluating rhythm disorders
Slide 6-

Echocardiography Std technique for assessing ventricular function Commonly used parameter in children Fractional shortening- ED diametr-ES diameter ED diameter normal – 28%to 42% Ef normal – 55-65%
Slide 7-

Essential for identifying Causes of HF such as structural heart disease Ventricular dysfunction (both systolic and diastolic) Chamber dimensions Effusions (both pericardial and pleural)
Slide 8-

Biomarkers Serum B type ntriuretic peptide- elevated in HF due to systolic dysfunction(CM) as well as with volume overload Cardiac troponin-elevated in cases of mycarditis, ischemic injury due to coronary anomaly, cardiomyopathy
Slide 9-

Pulse oximetry or hyperoxia test- 100% oxygen given and oxygen saturation is determined Metabolic and genetic testing Endomyocardial biopsy for acute myocarditis MRI cardiac- left n right ventricular function
Slide 10-

treatment Underlying cause Cardiac anomaly amenable to surgery – medical treatment to prepare the patient for surgery Lesion s nt reversible- medical treatment allows the child to b back to normal activities for some period and delay need for heart transplantion
Slide 11-

Treatment of the precipitating events Rheumatic activity, Infective endocarditis, Intercurrent infections, Anaemia, electrolyte imbalances, Arrhythmia, pulmonary embolism..
Slide 12-

General measures Bed rest and limit activities Nurse propped up or in sitting position Control fever Expressed breast milk for small infants Fluid restriction in volume overloaded Pulmonary edema – positive pressure ventilation Neonates with HF- nursed in an incubator, baby s kept propped up at 30 degree Child s restless or dyspneic- sedatives r used
Slide 13-

Diet Usually fail to thrive- increased metabolic demands and decreased caloric intake Increase calorie intake supplement breast milk Severely ill- not able to suck, nasogastric tube Older children- no added salt diet
Slide 14-

Goals of medical therpay Reducing preload Enhancing cardiac contractility Reducing afterload Improving oxygen delivery Enhancing nutrition Medical management of CCF should be tailored to specific details of each case
Slide 15-

diuretics Diuretics afford quick relief in pulmonary and systemic congestion. 1 mg/kg of frusemide is the agent of choice. For chronic use 1-4 mg/kg of frusemide or 20-40 mg/kg of chlorothiazide in divided dosages are used. Monitor electrolytes, urea and weight Spironolactone may be added 2 divided doses of 2mg/kg/day
Slide 16-

Afterload reducers- ACEI and ARBs Decreases peripheral vascular resistance and thereby improving mycardial performance Especially useful-HF secondary to cardiomyopathy n severe aortic n mitral insufficiency Additional benefits on preventing cardiac remodeling Captopril-0.3 to 6mg/kg ,Enalapril-0.05to 0.5mg/kg/day Nitrates- venodilators Hydralazine arterial dilators Nitroprusside used in icu settings
Slide 17-

Beta blockers Used in dialated cardiomyopathy Improve symptoms n survival Metoprolol selctive beta blocker Carvediol both alpha n beta blocker CCBs Should b avoided unless indicated for systemic HTN
Slide 18-

Phosphodiesterase inhibitor Milrinone- refractory to std therapy n post operative period in open heart surgery Positive inotropy n peripheral vasodialtaion IV 0.25to 1 microgm/kg/min
Slide 19-

Augmenting myocardial contractility Digoxin- Digitalization schedule- half total immediately subsequent 2 quarters at 12 hrs intervals ECG closely monitored maintenance digitalis after 12 hrs- daily dosage one quarter of digitalising dosage s divided into 2 n given at 12 hrs intervels
Slide 20-

Inotropes Usually administered in ICU settings Dopamine – beta adrenergic agonists(alpha adrenergic at higher doses) Selective renal vasodilatation( useful in patients compromised kidney functions) 2 to 10 micro gm/kg/min Fenoldopam – DA1 agonists Dobutamine – causes moderate reduction in peripheral vascular resistance 2 to 20 microgm/kg/min
Slide 21-

Isoproterenol- pure beta agoinists in patients with slow heart rates & less commonly used( chances of arrhythmias) Epinephrine in cardiogenic shock
Slide 22-

Manging acute CCF Admit to ICU Neoneates nursed in incubator Baby kept propped up at 30 degree Humidified oxygen Child is restless- morphine 0.05mg/kg SC Treat precipitating factors Diuresis with furosemide Significant hypotention- given dopamine infusion Reduce preload- nitrates After stabilisation look into cause
Slide 23-

Electro physiologic approach Biventricular resynchronisation pacing Improves cardiac output by maintaining normal synchrony between right n left ventricle contraction Correct underlying cause Surgical approach
Slide 24-

Thank you