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Pediatric Cardiology Emergencies

Learn about evaluation, treatment, and management of newborn problems related to cyanosis and low cardiac output in this comprehensive guide by Dr. Zahra Jalili from Imam Ali Cardiovascular Center.

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Pediatric Cardiology Emergencies

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  1. Pediatric Cardiology Emergencies Dr. Zahra Jalili Imam Ali cardiovascular center

  2. Newborn Problems • Cyanosis • Low Cardiac Output

  3. Newborn Problems - Cyanosis • Cardiac Cyanosis • Does not respond to oxygen • Does not respond to ventilation • Usually no respiratory distress

  4. Newborn Problems - Cyanosis • Evaluation • Chest x-ray • Arterial blood gasses • Echocardiogram

  5. Newborn Problems - Cyanosis • Right sided obstructive lesions • Pulmonary atresia • Tricuspid atresia • Tetralogy of Fallot

  6. Tricuspid Atresia

  7. Newborn Problems - Cyanosis • Abnormal Circulations • Transposition of the great arteries • Total anomalous pulmonary venous return

  8. Transposition of the Great Arteries

  9. TAPVR

  10. Newborn Problems - Cyanosis • Treatment • PGE1 • Restoration of acid/base balance • Surgical Evaluation

  11. Newborn Problems - Cyanosis • PGE1 • 0.1 mcg/kg/min • Any intravenous site • UAC • UVC • Peripheral • Interosseous

  12. Newborn Problems Low Cardiac Output • Shock • Metabolic acidosis • Circulatory shutdown

  13. Newborn Problems Low Cardiac Output • Evaluation • Chest x-ray • Arterial blood gasses • Echocardiogram • Electrocardiogram

  14. Newborn Problems Low Cardiac Output • Left Sided Obstructive lesions • Hypoplastic left heart • Critical aortic stenosis • Critical coarctation of the aorta

  15. Hypoplastic Left Heart

  16. Severe Coarctation

  17. Newborn Problems Low Cardiac Output • Muscle diseases • Myocarditis • Cardiomyopathies • Sepsis • Asphyxia

  18. Newborn Problems Low Cardiac Output • Heart Rate Problems • Supraventricular tachycardias • Complete heart block

  19. Newborn Problems Low Cardiac Output • Supraventricular Tachycardia • Narrow Complex • Heart Rate > 220 bpm • Usually > 240 bpm

  20. Narrow Complex Tachycardia

  21. Newborn Problems Low Cardiac Output • Complete Heart Block • Heart rate below 60 bpm • No relationship between P waves and QRS’s

  22. Complete Heart Block

  23. Newborn Problems • Treatment • Left heart obstructive lesions • Muscle diseases • Heart rate problems • PGE1 • Inotropic support and afterload reduction • Slow down or speed up

  24. Infant and Childhood Problems • Hypercyanotic spells • Congestive heart failure • Arrhythmias

  25. Infant and Childhood Problems • Hypercyanotic Spells • Tetralogy of Fallot • Pulmonary Atresia

  26. Tetralogy of Fallot

  27. Infant and Childhood Problems • Hypercyanotic Spells • Sudden decrease in pulmonary blood flow, usually in the morning • Provocation

  28. Hypercyanotic Spells • Treatment • Calming • Oxygen • Morphine • Beta Blocker • Phenylepherine

  29. Hypercyanotic Spells • Phenylepherine • Increase systemic vascular resistance which leads to less R - > L shunting and improved saturation

  30. Hypercyanotic Spells • Long Term Treatment with Propranolol • Indication for surgery, either palliative shunt or total repair

  31. Congestive Heart Failure • Differing etiology at different ages

  32. Congestive Heart Failure • Presentation in Infancy • Structural Diseases: Left Heart Obstructions • First days: Hypoplastic Left Heart Syndrome • Critical aortic stenosis • First month: Coarctation of the aorta • First 2 months: Left-to-right Shunts • VSD, PDA, Truncus Arteriosus

  33. Congestive Heart Failure • Presentation after infancy • Progression of structural heart disease • Arrhythmias • Infectious diseases • Later onset myopathies • Toxins: • Anthracyclines • Diphtheria

  34. Congestive Heart Failure Pre-load Contractility Heart Rate Determinants of Cardiac Output Afterload

  35. Congestive Heart Failure • Preload reduction • Diuretics • Fluid Restriction • High caloric density

  36. Congestive Heart Failure • Afterload reduction • ACE inhibitors • Nitroprusside

  37. Congestive Heart Failure • Heart Rate modification • Beta Blockers • Also treats diastolic dysfunction

  38. Contractility • Acute Treatment • Beta Agonists • Dobutamine • Afterload reduction also • Epinepherine • Dopamine • Increased myocardial demands • Milrinone

  39. Contractility • Milrinone increases contractility and reduces afterload without increasing myocardial oxygen demand

  40. Contractility • Chronic Treatment • Digoxin • New Treatments

  41. Arrhythmias • Narrow Complex Tachycardias

  42. Arrhythmias • Supraventricular Tachycardia

  43. Arrhythmias • Re-entrant Tachycardias • AV node re-entry • Wolfe-Parkinson-White

  44. Wolfe-Parkinson White

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