Paediatrics: Circulation: cardiovascular difficulty

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