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CONGESTIVE HEART FAILURE

Posted by SAMUEL ISABIRYE on February 5, 2013 at 4:50 PM

Inadequate cardiac output for the body’s needs

despite adequate venous return - may be due to

failure of both left and right ventricles.

 

Causes

 

z

Hypertension

z

Valvular heart disease, eg. rheumatic heart disease

z

Anaemia

z

Myocarditis

z

Prolonged rapid heart beat (Arrythimias)

z

Thyroid disease

z

Cardiomyopathy

z

Myocardial infarction

z

Congenital heart disease

 

Clinical features

 

Infants and young children

 

z

Respiratory distress with rapid respiration,

cyanosis, subcostal, intercostal and sternal

recession.

 

UCG 2010

197

 

 

 

9. Cardiovascular diseases

z

Rapid pulse, gallop rhythm

z

Excessive sweating

z

Tender hepatomegaly

z

Difficulty with feeding

z

Cardiomegaly

z

Wheezing

 

Older children and adults

 

z

Palpitations, shortness of breath, exercise in tolerance

z

Rapid pulse, gallop rhythm

z

Raised jugular venous pressure (JVP)

z

Dependent oedema

z

Enlarged tender liver

z

Fatigue, orthopnea, exertional dyspnoea

z

Basal crepitations

z

Wheezing

 

Differential diagnosis

 

z

Severe anaemia

z

Protein Energy Malnutrition (PEM)

z

Nephrotic syndrome

z

Asthma

z

Severe pneumonia

 

Investigations

 

¾

Chest X-ray

¾

Blood: haemogram

¾

Urea and electrolytes

¾

Echocardiogram

¾

ECG

 

Management HC4

 

f

Bed rest with head of bed elevated

f

Prop up patient in sitting position

f

Reduce salt intake

f

furosemide 20-40mg IV or oral increasing as

 

required to 80-160mg daily or every 12 hours

according to response

child: 1mg/kg IV or IM repeated prn according to

response (max: 4mg/kg daily)

 

UCG 2010 198

 

 

 

9. Cardiovascular diseases

f

ACE inhibitors start with small dose captopril

 

6.25 mg 8 hourly aiming for a maintainance dose

of 50 mg 8 hourly. Child: 1mg/kg daily. (Avoid if

systolic BP is less than 90 mmHg.)

Plus

 

f

Spironolactone for heart failure 25-50mg once

a day

child: initially 1.5-3mg/kg daily in divided doses

 

For acute pulmonary oedema:

 

f

morphine 5-15mg IM (0.1 mg/kg for children)

f

plus prochlorperazine 12.5mg IM

f

Repeat these every 4-6 hours till there is

 

improvement

f

Beta-blockers like carvedilol at specialised centers.

 

In urgent situations:

 

f

digoxin injection loading dose 250 micrograms

IV 3-4 times in the first 24 hours

Maintenance dose: 250 micrograms daily

child: 10 micrograms/kg per dose as above

 

In non-urgent situations:

 

f

digoxin loading dose 0.5-1mg orally daily in 2-3

divided doses for 2-3 days

maintenance dose: 250 micrograms orally daily

 

- elderly patients: 125 micrograms daily

child: loading dose: 15 micrograms/kg orally 3-4

times daily for 2-4 days

maintenance dose: 15 micrograms/kg daily for 5

days

Note

 

.

Ensure patient has not been taking digoxin in the

past 14 days before digitalizing, because of risk

of toxicity due to accumulation in the tissues

 

Prevention

 

z

Early diagnosis and treatment of the cause

z

Effective control of hypertension

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