RT Book, Section A1 Hollander, Seth A. A1 Bernstein, Daniel A2 Stevenson, David K. A2 Cohen, Ronald S. A2 Sunshine, Philip SR Print(0) ID 1109798144 T1 Management of Congestive Heart Failure T2 Neonatology: Clinical Practice and Procedures YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071763769 LK accesspediatrics.mhmedical.com/content.aspx?aid=1109798144 RD 2024/03/29 AB In neonates, congestive heart failure (CHF) secondary to congenital heart lesions predominates, with primary cardiac functional abnormalities (eg, dilated cardiomyopathy, myocarditis) relatively rare. When present, primary myocardial disease is associated with decreased intrinsic cardiac function and cardiac output, leading to tachycardia, diaphoresis, fluid overload, pulmonary congestion (secondary to increased left-sided filling pressures), feeding intolerance, ischemic injury of the brain and other end organs, and eventually death.1 In contrast, in patients with heart failure secondary to congenital heart disease, several mechanistic pathways and modes of presentation exist. In left ventricular (LV) obstructive lesions (eg, critical aortic stenosis), severely increased afterload depresses apparent cardiac function even if the muscle itself is normal. In severe forms in which subendocardial fibrosis is present, cardiac contractility may be truly reduced. In patients with left-to-right shunts, intrinsic cardiac contractile function is either normal or enhanced, and cardiac output is usually well preserved until the late stages of disease. Increased (and inefficient) cardiac work results in typical heart failure symptoms as described, with end-stage heart failure manifesting as reduced end-organ perfusion secondary to selective vasoconstriction, cardiovascular collapse, and death.