Congestive Cardiac Failure

Congestive Cardiac Failure

A. Congestive Cardiac Failure
Def.: Inability to maintain an output necessary for
metabolic needs of the body (systolic failure) and
inability to receive blood into ventricular cavities. At low
pressure 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

Lesion

Birth to 72 hrs

Pulmonary, mitral & aortic

atresias

4 days to I week

Hypoplastic left heart, TGA

1 to 4 weeks"

Endocardial fibroelastosis,
Coarctation of the aorta
transposition complexes
1-2 months

Endocardial cushion
defects. VSD. PDA, TAPVC
Anomalous left coronary
artery

Table: Symptoms of congestive cardiac failure

i. Poor weight gain
ii. Difficulty in feeding
iii. Breathes too fast; breathes better when held
against the shoulder
iv. Persistent cough and wheezing
v. Irritability, excessive perspiration and
restlessness
vi. Pedal edema
Table: Signs of congestive cardiac failure in infants
Left-sided
failure

Failure of either
side

Right-sided
failure

Tachypnea

Cardiac
enlargement

Hepatomegaly

Tachycardia

Gallop rhythm

Facial edema

(s3)
Cough

Peripheral

Jugular venous

cyanosis
Wheezing

Small volume
pulse

Engorgement

Rales in chest

Absence of
weight 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 or
triamterene
b. Step 2Digoxin
c. Step 3ACE inhibitors and stop potassium
sparing diuretics
d. Step 4isosorbide nitrate
e. Step 5Dobutamine/dopamine
f. Step 6Myocardial biopsy and add
immunosuppressive with steroids
g. Step 7 - cardiac transplantation
Digoxin
a. Augments cardiac contractility (Positive
ionotropic)Q
b. Total digitalizing dose- 0.04 mg/kg (o.06 1-3
yrs)
c. 1st dose -1/2
d. 2nd dose1/4 after 8 hrs
e. 3rd 1/4 after another 8 hrs
f. Parenteral dose 7/10 or 2/3 of the oral
g. Toxicities-vomiting, X 1.5 pr interval of base
line.

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