Curable Heart Failure in Pediatric Population

Case -1

  • 10 day old
  • Term – Vaginal delivery
  • Birth weight – 2.9Kg
  • No Immediate post natal complications
  • Discharged on day – 3

Case details

  • Presented on DOL – 10
  • Respiratory distress
  • Decreased feeding

At Admission

  • Poor perfusion
  • Cold peripheries
  • Respiratory distress
  • Cardiogenic Shock
    – Differential diagnosis ??

Clinical

  • Low blood pressures
  • Needed high inotropes – adrenaline Dopamine
  • No sig improvement
  • Metabolic acidosis
  • High lactate

Post stenting

  • Inotropes changed to Milrinone and Dobutamine
  • Ventilator support
  • Blood transfusion – PRBC
  • Albumin transfusion
  • Gradual improvement in ventricular function –24 hours to 48 hours
  • Improved Renal parameters

CHF in Children

Conventional (textbook) treatment

  • Supportive treatment
    – Decongestive drugs
  • Treatment of co-morbid conditions
    – Anemia, infection, etc.
  • Cause specific treatment

CHF in Children

Trends

  • Cause specific treatment:
    – Increasing emphasis on quickly identifying
    and treating the precise underlying cause
  • Supportive treatment:
    – Physiologically appropriate drug therapy

CHF in Children: Causes

  • Structural heart disease
    – Congenital heart defects
    – Acquired heart disease
  • Arrhythmias
  • Extra cardiac conditions
    – High-output states
  • Heart Muscle disease

Structural Heart Disease as cause of Heart failure

  • Surgery/Transcatheter intervention: The vast majority of congenital heart defects can be addressed
  • Today there is a greater emphasis on early diagnosis and early specific intervention

Heart failure in Large Left to Right Shunts

  • Uncontrolled CCF in a infant is a Class I indication for surgical correction
  • ntensification of medical therapy often does not improve the clinical status
  • Age and weight should not be considered as barriers for definitive correction
  • With experience and expertise, surgical correction can be performed with no incremental risks, with optimal results

CHF in Children

  • Arrhythmias:
    – Tachycardiomyopathy – A diagnosis not to be Missed !
  • Identification
    – Atrial flutter
    – Ectopic atrial tachycardia, atrioventricular
    tachycardia, atrioventricular nodal tachycardia
    – Ventricular tachycardia
  • Appropriate Drug Therapy / Cardioversion
  • Radiofrequency ablation

Conditions that can be incorrectly labeled as ‘idiopathic’ dilated cardiomyopathy

  • Anomalous Left Coronary Artery from Pulmonary Artery: ECG, High resolution echocardiography
  • Tachyarrhythmias – PJRT, Ectopic atrial tachycardia: ECG, Holter
  • Coarctation: Careful physical exam, echo
  • Takayasu arteritis : All Peripheral pulses
  • Hypertension

CHF in Children: Identification of cause

Specific causes of myocardial dysfunction

  • Severe Hypocalcemia
    – Vitamin D Deficiency
  • Iron excess: hemochromatosis and thalassemia
  • Selenium deficiency
  • Carnitine deficiency
  • Anthracycline cardiotoxicity

Trends – In Management Pediatric Heart Failure

  • Cause specific treatment
    – Quickly identifying and treating the precise underlying cause
    – Cure