CONGESTIVE HEART FAILURE

Dr. MERIAH SEMBIRING .SpA

SUB BAGIAN KARDIOLOGI ANAK

SMF/BAGIAN ILMU KESEHATAN ANAK
RSUD ULIN/FK. UNLAM
BANJARMASIN
 DEFINITION

CLINICAL SYND.IN WHICH THE HEART IS UNABLE

TO PUMP ENOUGH BLOOD TO BODY TO MEET ITS
NEED,TO DESPOSE OF VR ADEQUETLY OR
COMBINATION OF THE TWO.
CAUSES :
1. CONGENITIAL HEART DISEASES WITH

VOLU/PRESSURE OVER LOAD(VSD,PDA,ECD)

2. ACQUIRED : - VIRAL MYOCARDITIS

- RHD

- DELATED CARDIOMYOPATHY :

- MDYSTROPY

- DOXORUBICIN

- METABOLIC ABN : - SEVERE HYPOXIA

- ACIDOSIS

- HYPO GLYCEMIA

- HYPOCALCEMIA
3.MYOCARDIAC INSUF/MISCELANEOUS :

- SVT

- COMP.HEART BLOCK

- SEVERE ANEMIA

-ACUT HYPERTENTION : - GNA POST INF

- ARF

CLINICAL MANIFESTATION
A. HISTORY :

- INFANTS : - POOR FEEDING → POOR WEIGH

- TAKYPNEA
- COLD SWEAT

- CHILDREN : - SHORTED BREATH

- EASY FATIG
- PUFFY EYELIDS
B. PHYSICAL EXAM
1. COMPENSATORY :
- TACHCICARDI,GALLOP RHYTM
- CARDIOMEGALY
- ↑ SYMPKITHETIC DISCHANGE
- GROWTH FAILURE
- COLD
- WET SKIN
2. PULMONARY VENOS CONGESTION ( LEFT SIDE FAIL )
- TACHYPNEA
- DYSPNEA ON EXERTION/POOR FEEDING-INF
- ORTHOPNEA
- WHEEZYING / PULMONARY CRACKES

3. SISTEMATIC VENOS CONGESTION ( RIGHT )

- HEPATOMEGALY
- PUFFY EYELIDS
- DISTENTION NECK VEIN/ ANKLE EDEMA
- SPLENOMEGALY → INFECTION (+)

C. LAB.EXAM

1. X-RAY :
- CARDIOMEGALY
CTR > 55% - INFANTS
> 50% - 1 THN
2. ECG :
- HELP DETERM PRESENT OF BLOCK
- HYPERTROPI ALL CHEMBER

3. ECHOCARDIOGRAPHY :
- ENLARGEMENT ALL CHEMBER
- IMPARMENT LV
- CAUSE
- EVALUATION TH

MANAGEMENT
A. GENERAL :

- CARDIAL POSITION/REST
- O2 HUMODITY  Sa O2 > 90 %
- FLUID RETRICTION, HIGH KALORI
SALT : < 0,5 gr / day
- DAILY BW MEASUREMENT
MANAGEMENT
A. GENERAL :
- CARDIAL POSITION/REST
- O2 HUMODITY
- SALT/ FLUID RETRICTION HAIGH KALORI
SALT : < 0,5 gr / day
- DAILY BW MEASUREMENT
B. PRINCIPLES OF TREATMENT
1. ELIMINATION CAUSE
2. ELIMINATION PRECIPATING
- INFECTION
- ANEMIA
- ARYTHMIA
- FEVER
3. CONTROL CHF
C.MEDICAL INTERVENTION

1. REDUCED PRE LOAD :

- DIURETIC
- VASO/VENODILATOR ( NITROGLICE )
2. REDUCED AFTER LOAD :
- VENODILATOR ( GLISERIN )
- ARTERIODATOR ( HIDRALAZIN )
- MIXED ( ACE INHIBITOR,CAPTOPRIL )
3. ↑ CORTRACTILITY/INOTROPHIC
- DIGOXYN
4. HEARTY RATE :
- DRUG
- CARDIAL TRACIN

D. SURGICAL INTERVENTION