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Congestive Cardiac Failure

  1. Congestive Cardiac Failure

Def.:  Inability to maintain an output necessary for metabolic needs of the body (systolic failure) and inability to receive blood into ventricular cavities. At low pressure during diastole (Diastolic Failure)

Causes Of Diastolic Failure:

  1. Mitral or tricuspid stenosis
  2. Constrictive pericarditis
  3. Restrictive cardiomyopathy

Miscellaneous causes of 'CHF in infancy:

  1. Infections                    
  2. Hypoglycemia
  3. Hypocalcemia              
  4. Neonatal asphyxia 

Time of onset of chf in congenital lesions




Birth to 72 hrs

Pulmonary, mitral & aortic atresias

4 days to I week

Hypoplastic left heart, TGA

1 to 4 weeks"

Endocardial fibroelastosis, Coarctation of the aorta transposition complexes

1-2 months

Endocardial cushion defects. VSD. PDA, TAPVC

Anomalous left coronary artery


Table: Symptoms of congestive cardiac failure

  1. Poor weight gain
  2. Difficulty in feeding
  3. Breathes too fast; breathes better when held against the shoulder
  4. Persistent cough and wheezing
  5. Irritability, excessive perspiration and restlessness
  6. Pedal edema

Table: Signs of congestive cardiac failure in infants

Left-sided failure

Failure of either side

Right-sided failure


Cardiac enlargement



Gallop rhythm (s3)

Facial edema


Peripheral cyanosis

Jugular venous


Small volume pulse


Rales in chest

Absence of weight gain

Edema on feet


Myocardial diseases as a cause of CHF:


The commonest cause of myocarditis is Coxsackie B** infection


Primary myocardial diseases causing CCF:

  1. Glycogen storage disease
  2. Endocardial fibroelastosis
  3. Medial necrosis of coronary arteries 

Stepwise management of CHF:

  1. Step 1—Frusemide with amiloride or triamterene
  2. Step 2—Digoxin       
  3. Step 3—ACE inhibitors and stop potassium sparing diuretics
  4. Step 4—isosorbide nitrate
  5. Step 5—Dobutamine/dopamine
  6. Step 6—Myocardial biopsy and add immunosuppressive with steroids
  7. Step 7 -  cardiac transplantation 


  1. Augments cardiac contractility (Positive ionotropic)Q
  2. Total digitalizing dose- 0.04 mg/kg (o.06 1-3 yrs)
  3. 1st dose -1/2
  4. 2nd dose—1/4 after 8 hrs
  5. 3rd — 1/4 after another 8 hrs
  6. Parenteral dose —7/10 or 2/3 of the oral
  7. Toxicities-vomiting, X 1.5 pr interval of base line.

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