Managing Acute Congestive Heart Failure In The Neonate Or Infant
Acute presentation of the ill newborn or infant with congestive heart failure warrants immediate concern regarding potential sepsis or ductal-dependent congenital heart disease. The evaluation and treatment of these patients are often best performed in the neonatal or pediatric intensive care unit .
The initial management involves the usual assessment of the patient’s airway, breathing, and circulation ; achieving IV access; laboratory testing, including a blood culture; and empiric antibiotic therapy. Management of low cardiac output can be initiated by using a dopamine infusion of 5-10 mcg/kg/min; acidosis can be corrected with the administration of fluid and/or bicarbonate.
Calcium should be administered when hypocalcemia is documented. Because ductal-dependent structural heart disease is a common cause of congestive heart failure in early infancy, echocardiography should be considered early in the evaluation if a diagnosis is not immediately forthcoming.
Anatomic lesions that may appear early and that should be considered include the following:
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Coarctation or interruption of the aortic arch
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Total anomalous pulmonary venous return
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Hypoplastic left heart syndrome
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Truncus arteriosus
Symptoms Of Heart Failure
Symptoms of heart failure include:
- new or worsening shortness of breath
- difficulty lying flat at night
- fainting or passing out
- weight gain
- muscular fatigue, tiredness
- swelling of ankles or legs
- swelling of abdomen
- heart palpitations
- chest pain or discomfort in parts of the upper body
- unexplained coughing and wheezing
- constipation.
What Is The Outlook For Children With Ventricular Septal Defects
Overall, the outlook for a child with a ventricular septal defect is excellent. As previously described the majority of defects close on their own or are small so that treatment is not needed. Surgical results are also excellent. If the child has only a ventricular septal defect and an otherwise normal heart, the operative mortality approaches 0%. Major complications are rare and include heart block and incomplete closure of the defect. The incidence of major complications is less than 1%.
References
Gumbiner CH & Takao A. Ventricular septal defect. In Garson A, Bricker J, Fisher D & Neish S , The science and practice of pediatric cardiology, Vol I. Williams & Wilkins: Baltimore, MD, 1997,1119-1140.
Mavroudis C, Backer Cl, & Idriss FS. Ventricular septal defect. In C Mavroudis & C Backer Pediatric Cardiac Surgery. Mosby, St. Louis, MO,1994,201-224.
Onat T, Ahunbay G, Batmaz G & Celebi A. The natural course of isolated ventricular septal defects during adolesence. Pediatr Cardiol 19:230-234, 1999.
Reviewed September, 2012
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When To Call The Doctor
- Is tired or weak.
- Feels short of breath when active or at rest.
- Has a bluish skin color around the mouth or on the lips and tongue.
- Is wheezing and having trouble breathing. This is seen more in infants.
- Has a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit.
- Has swelling in the feet, ankles, or legs.
- Has gained or lost weight.
- Has pain and tenderness in the belly.
- Has a very slow or very fast pulse or heartbeat, or it is not regular.
- Has blood pressure that is lower or higher than is normal for your child.
Caring For Infants With Congenital Heart Disease And Their Families
REBECCA B. SAENZ, M.D., DIANE K. BEEBE, M.D., and LARAMIE C. TRIPLETT, M.D., University of Mississippi Medical Center, Jackson, Mississippi
Am Fam Physician.;1999;Apr;1;59:1857-1866.
;See related patient information handout on congenital heart disease, written by the authors of this article.
The reported incidence of congenital heart disease is eight cases per 1,000 live births.1 Family physicians must know how to screen for cardiac defects in infants, how to stabilize infants with these problems and how to manage their problems in teamwork with a pediatric cardiologist and a cardiac surgeon. As patient advocates, we also must be prepared to help the parents and other family members cope with the psychosocial aspects of chronic disease in a child.
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How Is Heart Failure Treated In A Child
Treatment will depend on your childs symptoms, age, and general health. It will also depend on how severe the condition is.
If heart failure is caused by a congenital heart defect, correcting the defect may cure the heart failure. Medicines are often used to treat heart failure in children. They may;include:
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Digoxin. This is a medicine that can help the heart beat stronger with a more regular rhythm.
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Water pills . These help the kidneys get rid of extra fluid that may build up in the body.
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ACE inhibitors. These medicines help open the blood vessels and lower blood pressure. This makes it easier for your child’s heart to pump blood to the body.
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Beta blockers. These help lower;the heart rate and blood pressure. This also makes it easier for the heart to pump blood to the body.
Other treatments include:
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Pacemaker. Some children with heart failure need an artificial pacemaker. The pacemaker may help when the heart is not pumping well because of a slow heartbeat.
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Cardiac resynchronization therapy. This uses a special type of pacemaker. This treatment may be used in some children with long-term heart failure.
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Mechanical support devices. Children with severe heart failure may be helped with special devices and tools. Your child may use these while waiting for a heart transplant.
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Heart transplant. A healthy donor heart replaces your child’s diseased heart.
Nursing Care Plan For Congestive Heart Failure
Nursing Care Plan for Congestive Heart Failure – CHFCongestive Heart Failure
- narrowed arteries that supply blood to the heart muscle coronary artery disease
- past heart attack, or myocardial infarction, with scar tissue that interferes with the heart muscle’s normal work
- high blood pressure
- heart valve disease due to past rheumatic fever or other causes
- primary disease of the heart muscle itself, called cardiomyopathy.
- heart defects present at birth congenital heart defects.
- infection of the heart valves and/or heart muscle itself endocarditis and/or myocarditis
Congestive Heart Failure Symptoms and Signs
Nursing Diagnosis
Nursing Intervention
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How To Feed Your Baby
Either breast- or bottle-feeding works well for babies with heart problems, but it’s important to be flexible about your feeding method and schedule. Some babies with heart disease may also require feeding supplements to their formula or breast milk, or require feeding through a feeding tube placed into the nose.
Babies with congenital heart disease typically do best when fed more often and on a demand schedule. They tend to tire quickly during the feeding, so frequent feedings tend to work well. Initially, you may need to feed your baby every two hours, and you may need to wake your baby several times during the night to feed him or her until he or she is able to tolerate a larger volume of milk. Some infants do best with a combination of breast- and bottle-feeding.
What Else Should I Know
As kids get older, it’s important to help them learn how to take charge of their medical care. A younger teen could fill a prescription or schedule an appointment. Older teens should understand health insurance coverage and know how to access their medical records.
Help an older teen move from a pediatric cardiologist to one who cares for adults. He or she should play an active role in choosing the new doctor. Encourage your child to make appointments, ask questions and take notes, and set aside time to speak with the doctor alone.
To prepare for adulthood and manage their health care, teens should know:
- about their heart condition
- when to get care
- the names of all medicines, their dosages and when to take them, common side effects, and interactions with other medicines
- if they have allergies to food or medicine
- the answers to most questions about their health and medical history
- how to:
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Friends And Family Can Often Provide Much
Managing heart failure isn’t always easy. Physically, many people with heart failure often can’t handle all the tasks they once could. They also have to change their lives eating differently, remembering medications, paying closer attention to their bodies and reducing stress. These changes can be hard because they often require breaking long-held habits.
But the changes are usually easier to make when loved ones provide much-needed support and care. If you live with or are close to someone who has heart failure, you’re likely to have the greatest impact on their success by following instructions from the healthcare team.
About Congestive Heart Failure
Heart failure, sometimes called congestive cardiac failure , is a condition in which the heart muscle is weakened and cant pump as well as it usually does. The main pumping chambers of the heart can change size and thickness, and either cant contract or cant relax as well as they should. This triggers fluid retention, particularly in the lungs, legs and abdomen.
The major causes of heart failure include coronary heart disease and heart attack, high blood pressure, damage to the heart muscle , heart valve problems and abnormal heart rhythms. Of these, coronary heart disease and heart attack are the most common causes.
The major factors that contribute to coronary heart disease include:
- reduced emotional and social wellbeing
- physical inactivity.
Heart failure is more common in elderly people. The survival rate for people with this disorder depends on the severity of their condition.
Most common treatments for heart failure are medications and self-managed lifestyle changes. Some less-common treatments may require insertion of implantable cardiac devices;or valve replacement.
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Heart Failure In Children
Heart failure is a condition that results when the heart is no longer able to effectively pump oxygen-rich blood to the rest of the body to meet the needs of the body’s tissues and organs.
Parents and caregivers, as well as older children with heart failure, must learn to:
- Monitor and manage care of heart failure in the home setting.
- Recognize the symptoms that heart failure is getting worse.
Common Congenital Heart Defects
Congenital heart defects are classified into two broad categories: acyanotic and cyanotic. In acyanotic defects, congestive heart failure is the most common symptom. The most common acyanotic lesions are ventricular septal defect, atrial septal defect, atrioventricular canal, pulmonary stenosis, patent ductus arteriosus, aortic stenosis and coarctation of the aorta. In infants with cyanotic defects, the primary concern is hypoxia. The most common defects associated with cyanosis are tetralogy of Fallot and transposition of the great arteries. These nine lesions constitute 85 percent of all congenital heart defects.9; Table 1 highlights some of the features of these lesions. The remaining 15 percent are often cyanotic defects9 and include tricuspid atresia, total anomalous pulmonary venous return, truncus arteriosus and hypoplastic left heart.
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Which Intervention Should Be Included In The Plan Of Care For An Infant With The Nursing Diagnosis Of Excess Fluid Volume Related To Congestive Heart Failure
a. Weigh the infant every day on the same scale at the same time.b. Notify the physician when weight gain exceeds more than 20 g/day.c. Put the infant in a car seat to minimize movement.d. Administer digoxin as ordered by the physician.
Answer: A
Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention. Weighing the infant on the same scale at the same time each day ensures consistency. An excessive weight gain for an infant is an increase of more than 50 g/day. With fluid volume excess, skin will be edematous. The infants position should be changed frequently to prevent undesirable pooling of fluid in certain areas. Lanoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid.
What Happens After Treatment
Kids treated for a defect will need regular visits with a pediatric cardiologist. At first, these visits might happen often perhaps every month or two. Later, they might be cut back, sometimes to just once a year.
The cardiologist may use tools like X-rays, electrocardiograms , or echocardiograms to watch the defect and the effects of treatment.
Some physical activities might be limited, but kids can still play and explore with friends. Always check with the cardiologist about which activities are OK for your child and which to avoid. Some competitive sports could be off limits, for example.
Preventing Infection
Infective endocarditis is an infection of the tissue that lines the heart and blood vessels. Kids with heart defects used to get;before procedures that could let get into the bloodstream, such as:
- dental work
- surgery in body areas where bacteria tend to grow, such as the mouth or gastrointestinal tract
But now, preventive antibiotics are given only to some children with heart defects. This includes those who:
- have a type of congenital heart disease that causes cyanosis;
- have had infective endocarditis before
- had their defect repaired with prosthetic material or device
The cardiologist will know the latest guidelines, and can advise you based on your child’s diagnosis.
Kids with heart defects should take good care of their teeth. They should brush and floss daily, and have regular dental visits and cleanings as often as the dentist recommends.
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What Is A Ventricular Septal Defect
A ventricular septal defect is a hole in the wall that separates the hearts two lower chambers . Ventricular septal defects usually occur by themselves, without other birth defects of any kind. Experts estimate that VSDs account for about 30 percent of all congenital heart defects, occurring in 1 out of every 500 babies.
Being A Caregiver Has Its Own Challenges
Being a caregiver for someone with heart failure requires a long-term commitment of time and energy.
As a caregiver, you need a plan and you need support. You’re not alone. We’ve provided a guide;to get you started, and many support groups are online and in your community. Ask the healthcare professionals involved in the patient’s care for contact numbers and help in giving care. And, most importantly, remember that you need to take care of yourself. With proper planning and support, caregiving can be very rewarding.
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Types Of Congenital Heart Disease
Though there are many different types of congenital heart defects, they can be divided into three main categories:
- In heart valve defects, the valves inside the heart that direct blood flow may close up or leak. This interferes with the hearts ability to pump blood correctly.
- In heart wall defects, the natural walls that exist between the left and right sides and the upper and lower chambers of the heart may not develop correctly, causing blood to back up into the heart or to build up in places where it doesnt belong. The defect puts pressure on the heart to work harder, which may result in high blood pressure.
- In blood vessel defects, the arteries and veins that carry blood to the heart and back out to the body may not function correctly. This can reduce or block blood flow, leading to various health complications.
Congestive Heart Failure Treatment:
Specific treatment for CHF will be determined by you and your child’s physician based on:
- Your child’s age, overall health and medical history
- Extent, type and typical history of the disease
- Your child’s tolerance for specific medications, procedures or therapies
If heart failure is caused by a congenital heart defect or an acquired heart problem such as rheumatic heart disease, surgical repair of the problem may be necessary. Medications often are helpful in initial treatment of CHF. Eventually, medications may lose their effectiveness and many congenital heart defects will need to be repaired surgically. Medications also may be used after surgery to help the heart function during the healing period.
Medications that commonly are prescribed to treat CHF in children include the following:
- Digoxin – helps strengthen the heart muscle, enabling it to pump more efficiently
- Diuretics – help the kidneys remove excess fluid from the body
- Potassium-sparing diuretics;- ;help the body retain potassium, an important mineral that often is lost when taking diuretics
- ACE inhibitors;- dilate the blood vessels, making it easier for the heart to pump blood forward into the body
- B -blockers – help prevent the heart from working too hard to compensate and improves some of the body’s counter-productive responses to the stress of heart failure
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Factors That Can Worsen Symptoms Of Heart Failure
The symptoms of heart failure can be worsened by a number of factors, including:
- anaemia
- too much salt, fluid, or alcohol in the diet
- pregnancy
- some viral and bacterial infections
- kidney diseases
Treatment for heart failure may include:
- medicines, such as;
- diuretics to remove excess fluid and improve symptoms of heart failure
- mineralcortiocoid receptor antagonists are also recommended and used in most patients with heart failure to reduce mortality and hospitalisation
- ACE inhibitors to open up blood vessels, reduce blood pressure and reduce sodium retention and water retention
- certain beta-blockers to slow the heart rate and reduce its work
- aldosterone blockers to reduce blood pressure and reduce the effects of damage to the heart muscle
- ACE inhibitors, beta blockers and aldosterone blockers can increase survival and reduce the likelihood of hospitalisation.