CONGESTIVE CARDIAC FAILURE in children : Short summary

           

CONGESTIVE CARDIAC FAILURE

Evaluation

H/O breathing difficulty, tachycardia, hepatomegaly, crepitations at lung bases, cardiomegaly, edema and ascites.

Investigations

CBC, ESR, Chest X-ray, ECG, Echocardiography, ABG, cardiac enzymes, serum electrolytes, ASOT, CRP and blood culture, urine examination, urea and creatinine where indicated.

   

General Measures

·         Admit

·         Oxygen inhalations

·          Prop up position 20-30°

·         Maintain IV line

·         Salt restriction

·         Vitals signs 1 hourly for 24 hours (until patient becomes stable)

·         Intake output records

·         Fluid restrictions 2/3 rd of daily requirements

·         Treat underlying infections with antibiotics

Specific measures

·         If HB < 12 g%, give packed cell transfusion10 ml /kg slowly.

·         Diuretics.  Furosemide 2 mg/kg/dose I.V stat then 2 mg/kg/day in 2 divided  doses

Spironolactone 2-4 mg/kg/day in 2 divided dose

·         Digoxin                 total dose =0.04 mg/kg/day

Maintenance dose = 0.01 mg/kg/day

Rapid Digitalization total dose is 0.04 mg per kg 50% dose given IV initially followed by 25% of total dose) after 6-8 and hours and 25% after 16 hours .

                                               

·         Dopamine 5 micro gram/kg/minutes to improve renal perfusion and

·         Dobutamine 10-25 kg/minutes for inotropic effect.

·         Vasodilators  (captopril 1 -5 mg/kg/day) reduce after load  by peripheral vasodilatation,