Heart Failure in Children: Priyanka. R. Patel (MD, DTM&H)

HEART FAILURE IN
CHILDREN
Priyanka. R. Patel (MD, DTM&H)
THE HEART
• The heart is the central pump of the cardiovascular system that drives
blood through the blood vessels.
• It is a muscular structure, which is made up of four chambers.
• Two atria (right and left) which are separated from each other by the
interatrial septum.
• Two ventricles (right and left) which are separated from each other by the
interventricular septum
The human heart contains four valves:
• Two atrioventricular valves (AV valves) between the atria and the
ventricles
• Tricuspid valve between the right atrium and the right ventricle.
• Mitral valve between the left atrium and there left ventricle.
• Two semilunar valves:

• Aortic valve between the left ventricle and the aorta.
• Pulmonary valve between the right ventricle and the pulmonary trunk.
FLOW CHART BLOOD FLOW IN THE
HEART:
BLOOD FLOW FROM THE HEART
• During ventricular systole, blood is pumped into the circulation
• During diastole, the pumping of blood stops and the ventricles get
filled with blood
CARDIAC OUTPUT:
• Cardiac output is the blood flow generated by ventricles per minute.
• The cardiac output is equal to the volume of blood pumped by

ventricles per beat × the number of beats per minute:
• Q = SV × HR
• Where Q = cardiac output, SV = stroke volume, and HR = heart rate.
FACTORS AFFECTING CARDIAC
PERFORMANCE
• CO depends on: stroke volume and heart rate.
• Stroke volume is dependent on three important factors:

• preload
• Afterload and
• contractility
• Preload = volume of blood received by the heart.
• Basically, preload is stretch.
• The amount of volume being returned to the heart.
• Afterload = pressure or resistance the heart has to overcome to eject

blood.
• Afterload is squeeze.
• The amount of resistance that the heart has to overcome in order to eject
blood.
HEART FAILURE:
• CHF is defined as the pathophysiologic state in which the heart is
unable to pump blood at a rate commensurate (proportionate) with
the body's metabolic needs (oxygen delivery).
• Heart failure occurs when the heart cannot deliver adequate cardiac
output to meet the metabolic needs of the body.
FACTORS AFFECTING CARDIAC
PERFORMANCE
• Preload:
• Preload (volume overload).
• Such as in VSD, or valvular insufficiency
• Afterload:
• Afterload is the resistance (pressure) against which the heart must pump blood: e.g;
systemic vascular resistance.
• Such as in aortic stenosis, pulmonary stenosis, or coarctation of the aorta
• Contractility
• Contractility (Cardiac Performance Independent of Preload or Afterload)
• Volume overload is the most common cause of CHF in children
COMPERNSATORY MECHANISMS
• (1) Cardiac compensation
• – increased HR and cardiac contractility
• – Cardiac dilatation (The Frank-Starling mechanism)
• – Myocardial hypertrophy
• (2) Systemic compensation

• – Increase the blood volume
• – Redistribution of blood flow
• – Increase of erythrocytes
• – Increased ability of tissues to utilize oxygen
•
• (3) neurohormonal compensation
• – Sympathetic nervous system
• – Renin-angiotensin system
• – Atrial natriuretic peptide; endothelin
ETIOLOGY OF HF:
ETIOLOGY OF HEART FAILURE
• In the first weeks of life, CHF is most commonly due to an excessive
afterload being placed on the myocardium.
• CHF presenting around 2 months of age is usually due to increasing

left-to-right shunts of congenital heart defects that become apparent
as the pulmonary vascular resistance decreases.
• Acquired heart disease, such as myocarditis and cardiomyopathy, can

present at any age.
CLASSIFICATION:
• (1) According to the course of disease
1) Acute HF
2) Chronic HF
• (2)According to the cardiac output (CO)

1) Low-output HF: due to volume overload, pressure overload & contractility
problems.
2) High-output HF: Heart Rate is primarily affected;3A(Anemia, Arrythmia, AV
Fistula)
• (3) According to the location of heart failure
1) Left -side heart failure (LHF)
2) Right-side heart failure (RHF)
3) Biventricular failure (whole heart failure)
• (4)According to the function impaired

1) systolic failure :Myocarditis, hypertension
2) Diastolic failure: restrictive cardiomyopathy, cardiac tamponate.
CLINICAL FEATURES:
• Infants: poor feeding, failure to thrive, tachypnea, and diaphoresis
with feeding.
• Older children: shortness of breath, easy fatigability, and edema.
• The physical examination findings depend on whether pulmonary

venous congestion, systemic venous congestion, or both are present.
• Tachycardia, a gallop rhythm, and thready pulses may be present with
either cause.
• If left-sided failure is predominant:

• tachypnea, orthopnea, wheezing, and pulmonary edema are seen.
• If right-sided failure is present:

• hepatomegaly, edema, and distended neck veins are present.
IMAGING STUDIES:
• chest x-ray: cardiomegaly
• ECG: Arrhythmias
• An echocardiogram assesses the heart chamber sizes, measures

myocardial function accurately, and diagnoses congenital heart defects
when present.
TREATMENT PRINCIPLES:
• (1) Correct the underlying causes of HF
• (2) Diet; (low salt and high calories)
• (3) Digitals; Improve the cardiac contractility
• (4)Diuretics; Reducing preload: frusemide
• (4) Dilators; Reducing afterload; ACE
Remember 4 D
TREATMENT:
Diuretics: reduce preload
Inotropes -
Improve cardiac contractility
Dilators – reduce afterload
Thanks for listening :-)

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HEART FAILURE IN

• It is a muscular structure, which is made up of four chambers.

• Two semilunar valves:

• The cardiac output is equal to the volume of blood pumped by

• Stroke volume is dependent on three important factors:

• Afterload = pressure or resistance the heart has to overcome to eject

• (2) Systemic compensation

• CHF presenting around 2 months of age is usually due to increasing

• Acquired heart disease, such as myocarditis and cardiomyopathy, can

• (2)According to the cardiac output (CO)

• (4)According to the function impaired

• Older children: shortness of breath, easy fatigability, and edema.

• The physical examination findings depend on whether pulmonary

• If left-sided failure is predominant:

• If right-sided failure is present:

• An echocardiogram assesses the heart chamber sizes, measures

• (2) Diet; (low salt and high calories)

• (3) Digitals; Improve the cardiac contractility

• (4)Diuretics; Reducing preload: frusemide

• (4) Dilators; Reducing afterload; ACE

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