Paediatrics: Circulation: cardiovascular difficulty

2021-03-10 12:00 AM

The failure to deliver adequate oxygen to the tissues: ·Heart rate disturbance: bradycardia, dysrhythmias. ·Decreased stroke volume: hypovolaemia; vasodilatation; poor contractility.

Circulation: cardiovascular difficulty

Shock

The failure to deliver adequate oxygen to the tissues:

  • Heart rate disturbance: bradycardia, dysrhythmias.
  • Decreased stroke volume: hypovolaemia; vasodilatation; poor contractility.

Congestive heart failure

Cardiac fatigue due to:

  • Excess volume load: from left-to-right cardiac lesions (ventricular septal defect (VSD), patent ductus arteriosus (PDA), arteriovenous (AV) canal), AV fistula, severe anaemia, hypervolaemia.
  • Excess pressure load: from the systemic vascular system (aortic stenosis, coarctation of the aorta, or hypertension) or pulmonary vascular system (pulmonary stenosis, pulmonary hypertension, chronic hypoventilation, or severe upper airway obstruction).
  • Myocardial problems: including cardiomyopathy, myocarditis, myocardial ischaemia (anomalous coronary artery, cardiac thrombosis in Kawasaki), metabolic disorders.
  • Excess myocardial demand: due to fever, thyrotoxicosis.

Dysrhythmia

uncommon, but consider:

  • Supraventricular tachycardia.
  • Congenital heart block.

Hypertension

causes of hypertension are:

  • Renal: glomerulonephritis; haemolytic–uraemic syndrome; pyelonephritis; obstructive nephropathy; vascular disease.
  • Cardiac: coarctation of the aorta.
  • Neurological: infection; drugs; tumour; cerebral oedema.
  • Endocrine: phaeochromocytoma; Cushing’s syndrome; corticosteroids; hyperthyroidism.
  • Toxins and poisons.
  • Primary essential hypertension.

Anaphylactic shock

the main causes are food, medication, and insect bites. Life-threatening problems are:

  • Respiratory: airway narrowing of the upper and lower airway.
  • CVS: shock, vasodilatation, and increased vascular permeability.

Pericarditis 

The causes include infection, rheumatological disorders, trauma, malignancy, and post-pericardiotomy syndrome.

Congenital heart disease