HEART FAILURE

Nur Zulaikha Tusiran

Reference
1. Nelson Textbook of Peadiatrics 19th
edition
2. Illustrated Textbook of Paediatrics 4 th
edition
3. Medscape:
http://
emedicine.medscape.com/article/154555overview
4. Netter Atlas cardiology 2 nd edition

Causes of Heart Failure

NeonatesObstructed (duct
dependent)
Systemic
circulation

Infants (high
pulmonary blood
flow)

Older children and

adolescents (right or
left heart failure)

Hypoplastic left heart

syndrome

Ventricular septal
defect

Eisenmenger
syndrome (right heart
failure only)

Critical aortic valve

stenosis

Atrioventricular
septal defect

Rheumatic heart
disease

Severe coarctation of Large persistent

the aorta
ductus arteriosus
Interruption of the
aortic arch

Cardiomyopathy.

Symptoms and signs of heart Failure

Symptoms
Breathlesess ( on feeding/
exertion)
Sweating
Poor Feeding
Recurrent chest infectiom
Signs
Poor weigh gain
Tachypnoea
Tachycardia
Heart murmur, gallop rhythm
cardiomegaly
Hepatomegaly
Cool peripheries

NEONATES & INFANTS

Poor feeding
Tachypnoea worsening
during feeding
Cold sweet on forehead
Poor weight gain
OLDER CHILDREN
Fatigue
Exercise intolerance
Dyspnoea
Puffy eyes & pedal
edema
Growth failure

Causes of HF in
Older children and
adolescents
(right or left heart
failure)

Eisenmenger syndrome

Child with a ventricular septal defect

which blood is shunted partially or
totally from right to left as a result of
the development of pulmonary vascular
disease.
Or atrioventricular septal defect, patent
ductus arteriosus or any other
communication between the aorta and
pulmonary artery.

Symptoms develop at 2nd and 3rd decadr of life.

Intracardiac / extracardiac communication that
normally shunt from to right are converted to
right-to-left shunting as pulmonary vascular
resistance exceeds systemic vascular
resistance Child will become more cyanosis,
dyspnoea, fatique, dysrhytmias .

How does the ES leads to

HF
Pulmonary
blood flow

Endothelial
dysfunction and
vascular
remodelling

Inverted shunt

RV pressure

PVR

EISENMENGER
SYNDROME

Impaired ability
of ventricle to
relax and fill
during diastole

Stroke
volume and CO

Left to right
shunt

HEART FAILURE

Rheumatic Heart Disease

Complication of rheumatic fever (mainly

affects children aged 5-15 years)
Valvular lesion begin as small verrucae
(vegetation) composed of fibrin & blood cells
along the borders of one or more of the heart
valves
Most common: Mitral valve, aortic valve

How does the RHD leads to HF

Streptococcal
Pharyngitis

Impaired Left
Ventricular
filling

CO

Left Heart
Failure

Rheumatic
Fever

RHD

Mitral Valve
Stenosis

Calcification of
valve leaflet
( Mitral/Aortic
Valve)

Left arterial
Pressure & size,
pulmonary
venous
congestion ,
pulmonary
hypertension
Right
Heart
pressure
Right
Ventricular
failure

Aortic Valve
stenosis

CO

Left Ventricular
hypertrophy

Cardiomyopathy
Intrinsic disease of the heart muscle .
3 types:
-Dilated ( most common and often
idiopathic),
-hyperthrophic (autosomal dominant
inheritance),
-Ristrictive (rare and usually associated
with systemic disease)

How does the cardiomyopathy leads to HF

Dilated
Cardiomyopathy

Contractility

Ventricular
Hyperthropy

CO

Heart failure