In recent years, childhood heart failure is becoming more common, becoming a very important not only medical, but also a social problem. It leads to disability, a decrease in the duration and quality of life of children.
Classification and causes of occurrence
Heart failure is a syndrome in which the contractility of the myocardium decreases, which leads to insufficient cardiac output and, as a result, poor blood supply to all organs and systems of the body.
The generally accepted degrees of heart failure in childhood are not applicable, therefore, children use their own classification:
Grade I is characterized by dyspnea at rest and an increase in heart rate by 25-30% of the norm. Cyanosis of the mucous membranes, which disappears with oxygen therapy. With auscultation of the heart, the muffledness of the heart sounds is determined.
II A degree: characterized by severe shortness of breath at rest (50% more than normal) and increased heart rate by 35-40%. Examination reveals cyanosis of the mucous membranes, acrocyanosis, edema around the eyes. On auscultation - deafness of heart sounds.
II B degree: characterized by the same changes as in A degree. Also, oliguria (a decrease in the amount of urine excreted) and peripheral edema, localized primarily on the legs and face, occur.
III degree is decompensatory. It is characterized by dyspnea at rest (increase by 80% of the norm), increased heart rate by 50-65% of the age norm. Pulmonary edema occurs. In the terminal stage, heartbeat and breathing slow down (bradycardia and bradypnea), blood pressure decreases, muscle hypotension occurs, and consciousness is inhibited.
Each age group can identify its most common causes of heart failure.
Newborn period - first month after birth:
- Congenital heart defects.
- Prolonged hypoxia.
- Violation of the restructuring of the blood circulation of the newborn - from intrauterine to extrauterine.
- Abnormal discharge of the coronary arteries from the aorta.
Infancy period:
- Myocarditis, pericarditis.
- Hereditary genetic syndrome.
- Cardiomyopathy.
Early preschool period:
- Infective endocarditis.
- Heart rhythm disturbances.
- Neuromuscular diseases, muscular dystrophies.
Late preschool period:
- Pulmonary hypertension.
- Acute rheumatic fever and rheumatism.
- Connective tissue diseases (vasculitis).
In all other periods of childhood, the causes of heart failure can occur from any of the above period.
Thus, heart failure can occur due to damage to the heart muscle at the cellular level (myocarditis, cardiomopathy), overload of the heart with pressure (with aortic, mitral, tricuspid stenosis - a strong pressure is needed to push blood through the narrowed opening), or due to overloading of the heart with volume ( insufficiency of heart valves, congenital heart defects).
Symptoms
The clinic of heart failure will differ depending on which part of the heart is most affected. In this regard, heart failure is distinguished according to the left ventricular and right ventricular types.
General signs of heart failure (typical for both left and right ventricular) can be seen from the very birth of the child.
| Criteria | Left ventricular type | Right ventricular type |
|---|---|---|
| Complaints | Fast fatiguability Decreased appetite Sweating Shortness of breath, first with exertion and then at rest Cardiopalmus Dry or wet cough | Fast fatiguability Weakness Sleep disturbance Dyspnea Nocturia, oliguria and anuria Cough |
| Objective symptoms | Forced semi-sitting position due to increased dyspnea while lying Participation in the act of breathing of the auxiliary muscles - retraction of the wings of the nose, retraction of the intercostal spaces Moist wheezing in the lungs Central cyanosis Hoarseness and aphonia Difficulty inhaling, but at the same time lengthening the exhalation | Swollen veins (in the neck, arms, legs, abdomen, chest) Epigastric pulsation Increase in size and pain on palpation of the liver. Violation of her function Spleen enlargement Dyspeptic disorders - diarrhea, constipation, nausea, vomiting Peripheral edema |
The newborn refuses to breast or suckles at long intervals, sucks a small amount of milk and does not gain weight. The child is very lethargic, his crying and crying are weak. The skin is pale, the subcutaneous pattern of the veins is clearly visible.
An infant lags behind in physical and neuropsychic development. He has marked shortness of breath and tachycardia. The child is lethargic, does not want to eat and play. A close examination can reveal hidden edema, since the tissues of children under one year old are highly hydrophilic and absorb excess fluid.
In further age periods, the symptoms are the same. Children are very lagging behind in growth, they have increased sweating. The color of the skin is pale at first, with the progression of the disease - blue, there may be acrocyanosis. Children refuse outdoor games, it is hard for them to run, jump, walk quickly. Whenever possible, they try to lie down somewhere. When walking at an average pace, children are often asked to stop and rest. There is severe shortness of breath and tachycardia. Peripheral edema on the legs, feet, ankles is noticeable, which intensifies towards the end of the day.
Atypical symptoms of heart failure include: abdominal pain (against the background of congestion in the liver, stomach, spleen), cough with phlegm, pain in the legs (painful swelling of the veins of the lower extremities), hoarseness, aphonia.
Diagnostics
Diagnosis in children is carried out by non-invasive methods: X-ray, Doppler echocardiography (ultrasound of the heart), electrocardiography, MRI, exercise test. In difficult cases of diagnosis, it is possible to use an invasive technique - cardiac catheterization.
The ECG does not show specific signs of heart failure. With its help you can get information about:
- Signs of myocardial ischemia.
- Signs of overload of the right or left heart.
- Violation of rhythm and conduction.
- Change and violation of repolarization.
X-rays will show:
- An increase in the shadow of the heart (an increase in the cardiothoracic index).
- Congestive changes in the pattern of the lungs (enhanced pattern).
Doppler echocardiography is the most informative and safe diagnostic method. Using it, you can identify:
- Decreased ventricular ejection fraction.
- Decreased stroke volume and cardiac output.
- Decrease in minute volume of blood circulation.
MRI is used when it is impossible to have a complete view with echocardiography, to assess the relative position of the heart, blood vessels, lungs and other organs. It makes it possible to obtain accurate indicators of the dimensions of the chambers and the muscle mass of the heart.
Catheterization is used extremely rarely, in cases where information about the oxygen content and pressure in the chambers of the heart is needed.
Timely diagnosis of heart failure in children is very important. A diagnosis not made on time can lead to dire consequences. Heart failure leads to a decrease in the blood supply to all organs, the main of which is the brain. The child will greatly lag behind in mental and mental development, and if treatment is not started during the time, the baby may never be able to catch up with his peers, growth may stop.This applies not only to the height of the small patient, but also to the lack of growth of internal organs. And the worst thing that can happen is multiple organ failure and death.
Treatment of heart failure in children
Treatment is aimed at prolonging and improving the quality of life of a sick child. Therapy is complex, it includes: impact on the etiological factor, changes in physical activity, increased contractility of the heart, correction of violations of insufficient blood supply to organs and prevention of complications.
Diet therapy, initially the recommended method, aims to increase the number of meals up to 5-6 times a day. Food should be varied, enriched with micro and macro elements (especially with a high content of potassium and calcium). Fatty foods, fish and meat broths, tea, coffee, chocolate and spicy foods should be excluded from the diet.
Physical activity - it is necessary to reduce physical activity to a moderate level. In severe cases, bed rest must be observed. In all others, a complete lack of physical activity leads to atrophy of all muscles, including the heart.
Drug therapy is aimed at:
- Increased contractility of the heart. This will help cardiac glycosides ("Digoxin", "Digitoxin", "Lantosid") and non-glycoside cardiotonics ("Dobutamine").
- Unloading the main organ with diuretics (Furosemide, Veroshpiron), angiotensin-converting enzyme inhibitors (Captopril, Enalapril) - they reduce the pre- and afterload on the heart, b-blockers (Propranolol) that reduce diastol, lengthen and arrhythmia.
- Prevention of thromboembolism and thrombosis - "Heparin", "Warfarin" will help.
- Improvement of trophism and metabolism in cells - the amino acid L-carnitine, potassium and magnesium preparations will cope with this.
With restless behavior in children, sedatives and antidepressants may be prescribed.
In the presence of respiratory failure, oxygen therapy is prescribed.
Heart failure in children is not a death sentence. With timely diagnosis, timely and correctly prescribed treatment, the prognosis for life and development in children is favorable. The earlier heart failure was detected, the cause of its occurrence was found and eliminated, the more chances that in a few years the parents and the child will not remember the existence of the disease.
