Congestive Heart Failure in newborns . Congestive heart failure is a clinical syndrome that is due to the inability of the myocardium to adequately maintain the demands of the body’s tissues
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- 1 Causes
- 2 Clinical picture
- 1 Myocardial signs
- 2 Signs of pulmonary congestion
- 3 Signs of systemic venous congestion
- 4 Radiological signs
- 3 Diagnosis of the disease
- 4 Sources
This myocardial failure is a consequence of:
- Excessive overload imposed on the Heart by structural defects.
- Myocardial disorders due to a toxic inflammatory process .
- Combination of mechanical and myocardial factors.
The sequelae of these factors are manifested by pulmonary and systemic venous congestion , adaptation mechanisms, and adrenergic factors. In the first week of life, the most frequent myocardial failure is Hypoplasia of the left heart , transposition of the great vessels and coarctation of the Aorta . In the first month of life, a major cause of myocardial failure is coarctation of the aorta associated with a ductus arteriosus and other injuries.
The following injuries are included in this age group:
- common atrioventricular canal
- Paroxysmal tachycardia
- Total abnormal drainage of the pulmonary veins below the Diaphragm
- Tricuspid atresia
- Common ventricle
- Persistent truncus arteriosus
- Complex lesions associated with splenic dysgenesis syndrome .
In the second month it is due to the transposition of the great vessels and the wide ventricular septal defect with the fall of the pulmonary resistances. In the third month, the ventricular septal defect associated with the ductus arteriosus or the atrial septal defect. From the third to the sixth month to the ventricular septal defect associated with other injuries or as an isolated injury. After six months of age, heart failure is less common; It is seen in cardiomyopathies , endocardial bearing defects, and abnormal drainage of pulmonary veins.
- Tachycardia .
- Gallop rhythm.
- Jumpy arterial pulse if fistula, truncus arteriosus or aortic regurgitation.
- Cardiomegaly .
- Sweats .
Lung congestion signs
- Tachypnea .
- Death rattles .
- Cyanosis .
- Paroxysmal dyspnea .
- Cough .
Signs of systemic venous congestion
- Hepatomegaly .
- Dilation of the neck veins.
- Edema .
- Increased heart area.
- Congestive hilies .
- Kerley lines .
The signs of Right Heart Failure are: increased systemic venous pressure, Hepatomegaly . The edema is less frequent and sometimes is minimal.
In left heart failure the most common signs are:
- Pulmonary rales , gallop rhythm, and radiological evidence of congestion in both lungs.
Diagnosis of the disease
- In the presence of aortic or [mitral] atresia ( left cavity hypoplasia syndrome ) with closed or reduced foramen ovale ; as the Blood from the Lung does not escape through the atrial septum , pulmonary venous congestion occurs with Dyspnea , Cyanosis , heart failure, Cardiomegaly and frequently no murmur is heard.
- Abnormal drainage of the pulmonary veins below the Diaphragm is manifested by severe pulmonary venous congestion from the first hours after birth; presents a picture of heart failure severe with Heart of normal size and the X – ray Thorax , signs of pulmonary edema .
- Children of a diabetic mother. They generally do not have heart failure, but when they have a ductus arteriosus or severe hypoglycemia, heart failure can occur.
- A placental transfusion at birth causes myocardial overload and heart failure. Plethoric children with congestive heart failure.
- Monozygotic twins , at birth, one of them can receive a lot of blood and the other anemic. The full-blooded baby may have Cardiomegaly and heart failure.
- In the idiomatic Polycythemia with a hematocrit of 65% encimadel these children have cardiomegaly and not infrequently heart failure.
- The Respiratory distress of newborns with ductus arteriosus may be difficult to distinguish from Congestive Heart Failure .
- Some children with left to right shunt have Polypnea , Cardiomegaly , without Congestive Heart Failure . When the short circuit is abundant and they are complicated by respiratory infection or the pulmonary resistances decrease, they can have myocardial failure.
- Cyanotic children with a right-to-left shunt and an Oligohemic Lung rarely have congestive heart failure