Congestive Heart Failure (CHF)
In pediatric patients, CHF is primarily a consequence of volume overload from congenital heart defects (CHDs) or, less commonly, primary myocardial dysfunction.
1. Common Etiology
- Left-to-Right Shunts (Volume Overload): Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA), Atrial Septal Defect (ASD).
- Obstructive Lesions (Pressure Overload): Coarctation of the Aorta, Aortic Stenosis.
- Myocardial Dysfunction: Myocarditis, Cardiomyopathy, Arrhythmias (e.g., SVT).
2. Principles of Management
| Goal | Intervention |
|---|---|
| Reduce Preload | Diuretics (Furosemide). |
| Reduce Afterload | ACE Inhibitors (Enalapril/Captopril). |
| Improve Contractility | Inotropes (Digoxin, Milrinone). |
| Supportive | High-calorie feeds, fluid restriction (if indicated). |
3. Clinical Pearls
Treatment should be phased: diuretics manage fluid overload, ACE inhibitors reduce the workload on the heart, and inotropes strengthen the pump. In neonates with ductal-dependent lesions (e.g., severe Coarctation), **Prostaglandin E1** infusion is life-saving to maintain ductal patency.
NEET PG Hint: Never forget that Digoxin has a narrow therapeutic index; watch for signs of toxicity (arrhythmias, bradycardia, vomiting). For high-yield practice questions and comprehensive coverage of pediatric cardiology, you can utilize resources available at mymedschool.org.