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Acquired Heart DS, HF
Acquired Heart DS, HF
Acquired Heart DS, HF
• Uncommon in Malaysia
Acute Inflammation of
carditis in Endocardium,
Valvular Myocardium and
Rheumatic
damage pericardium
fever
in RHD
Erythema Marginatum
Subcutaneous Nodules
Chronic rheumatic heart disease
• The most common form of long-term damage from scarring and
fibrosis of the valve tissue of the heart is mitral stenosis.
Signs • Pulses
• Mild to Moderate • Collapsing Pulse
• Often asymptomatic • Low diastolic pressure
• Palpitation • Murmur
• Early Diastolic Murmur (aortic
regurgitation)
• Severe • Systolic Murmur (aortic stenosis)
• Dyspnoea • Others
• Angina • Displaced Apex
• Fourth Heart Sound
• Crepitation
Symptoms
Rheumatic heart disease(Ix , Mx)
Splinter Haemorrhages
Janeway Lesions
Infective Endocarditis
Investigation and Management
• Rx
• IV high dose penicillin + aminoglycoside 6/52
• Surgical removal (infected prosthetic material)
IE Prophylaxis
• Practice of good dental hygiene in all children with congenital heart
disease
Antibiotic prophylaxis
• Required in
• Oral, dental procedures
• Surgery (likely to be associated with bacteraemia)
Antibiotic Prophylaxis
Antibiotic Prophylaxis
Antibiotic Prophylaxis
HEART FAILURE
Lim Kok Hong
Definition
• Inability of the heart to provide adequate cardiac output to meet the
metabolic demand of the body.
• primary determinants of stroke volume are the afterload (pressure
work), preload (volume work), and contractility (intrinsic myocardial
function).
• molecular/cellular level, such as upregulation or downregulation of
various metabolic pathway components leading to changes in
efficiency of oxygen and other substrate utilization.
• neurohormones such as the renin–angiotensin system and the
sympathoadrenal axis.
Heart
Failure
Low High
output output
Due to cardiac problem no basic abnormality in myocardial function, CO is
normal or increased, due to decreased in systemic
O2 content or increase O2 demand
Clinical features
• Varies according to age
• Infancy :
Symptoms : poor feeding, recurrent chest infection, failure to thrive,
excessive perspiration, weak cry, irritability
Signs : tachypnea, wheezing, subcostal and intercostal recession, nasal
flaring, tachycardia, weak pulses, hyperactive precordium, praecordial
bulge, hepatomegaly, edema generalized / usually involves eyelids,
sacrum
• Children:
Similar to adults
Fatigue, effort intolerance, anorexia, dyspnea, cough, abdominal
symptoms ( pain, nausea) , increase JVP, hepatomegaly,
edema/anarsaca, gallop rhythm, systolic murmur due to valve
regurgitation caused by advanced ventricular dilation
Diagnosis & Investigation
• X-ray : cardiac enlargement, increase pulmonary vascularity ( left to
right shunt) , perihilar pulmonary marking ( venous congestion, acute
pul. Edema)
• ECG : chamber hypertrophy
• Echocardiography : assessment of ventricular function
• Doppler : estimate Cardiac output, flow of blood,
• MRI : quantifying left & right ventricular function, volume, mass and
coronary artery anatomy, regurgitant fraction
• ABG : arterial oxygen level, respiratory/ metabolic acidosis
• Serum B-type natriuretic peptide : increased in cardiomyopathy,
volume overload HF
Treatment
General Measures
• Oxygen supplement
• Propped up position
• Keep warm
• Fluid restriction
• Optimize calories intake
• Correct anemia, electrolyte imbalance, chest infection
Pharmacological
• Diuretics
• Afterload reducer ( ACE inhibitors, Angiotensin II Receptor Blockers)
• Digitalis glycosides ( digoxin)
• α- and β-Adrenergic Agonists ( dopamine)
• Phosphodiesterase Inhibitors (Milrinone)
Diuretics
• Frusemide (loop diuretic)
• Dose: 1 mg/kg/dose OD to QID, oral or IV
• Continuous IV infusion at 0.1 – 0.5 mg/kg/hour if severe fluid overload
• Use with potassium supplements (1 - 2 mmol/kg/day) or add potassium
sparing diuretics.
Digoxin
• Role controversial
• Useful in heart failure with excessive tachycardia, supraventricular
tachyarrhythmias.
IV inotropic agents - i.e. Dopamine, Dobutamine, Adrenaline, Milrinone
• Use in acute heart failure, cardiogenic shock, post-op low output
syndrome.
Specific management