RT Book, Section
A1 Shaddy, Robert E.
A1 Ravishankar, Chitra
A2 Kline, Mark W.
SR Print(0)
ID 1182914838
T1 Heart Failure
T2 Rudolph's Pediatrics, 23e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259588594
LK accesspediatrics.mhmedical.com/content.aspx?aid=1182914838
RD 2024/04/20
AB Heart  failure  is  a  complex  condition  with  many  potential  causes,  but  with  the  end  result  of  the  inability  of  the  heart  to  keep  up  with  the  demands  of  the  body.  Many  feel  that  there  must  also  be  a  component  of  congestion  (either  systemic  or  pulmonary)  to  the  condition  of  heart  failure.  However,  some  patients  with  heart  failure  may  have  no  significant  congestion  at  rest,  but  only  develop  congestion  with  exertion  or  other  forms  of  increased  oxygen  demand.  Heart  failure  is  generally  precipitated  by  some  type  of  insult  to  the  cardiovascular  system,  either  acquired  or  congenital.  In  adults,  the  most  common  form  of  insult  is  ischemic  coronary  artery  disease  with  resultant  abnormal  left  ventricular  function.  In  children,  the  etiologies  of  heart  failure  are  rarely  ischemic  and  are  quite  varied  and  age-dependent.  Please  refer  to  Chapters  478  and  479  of  this  book  for  specific  lesions  associated  with  heart  failure  in  children  of  different  ages.  Although  infants  with  large  left-to-right  shunts  with  pulmonary  overcirculation  are  commonly  referred  to  as  being  in  heart  failure,  their  ventricular  performance  is  usually  normal,  and  their  “heart  failure”  is  usually  a  manifestation  of  pulmonary  overcirculation  and  elevated  ventricular  filling  pressures  secondary  to  this.  There  can  be  a  component  of  decreased  systemic  cardiac  output  as  well.  In  addition,  severe  left-sided  obstructive  lesions  (eg,  hypoplastic  left  heart  syndrome,  coarctation,  or  critical  aortic  stenosis)  often  present  with  heart  failure  in  the  newborn  period  due  to  the  inability  of  the  left  ventricle  to  adequately  eject  blood  to  the  systemic  circulation.  Both  of  these  lesions  are  generally  quite  well  managed  with  surgical  or  transcatheter  intervention  and  will  not  be  discussed  in  this  section.  Rather,  this  chapter  will  focus  on  the  type  of  pediatric  heart  failure  that  presents  acutely  (either  due  to  systemic  ventricular  dysfunction  or  after  cardiac  surgery)  or  develops  chronically,  primarily  as  a  result  of  decreased  systemic  ventricular  performance.