Causes of heart disease in the older child:
- congenital
- rheumatic heart disease
- renal disease
- post-Strep glomerulonephritis
- hypertension
- primary myocardial disease
- arrhythmias
Principles of Management
- rest
- ± prompt surgical therapy should be considered after initiating medical therapy, for: large left to right shunts, severe AS or COA, TGA with IVS, obstructed TAPVC, etc.
- identify and treat cause
- correct precipitating event – intercurrent infection, anemia, electrolyte imbalance, arrhythmia, rheumatic reactivation, infective endocarditis, drug interaction, drug toxicity, drug noncompliance
- treatment of systemic or pulmonary congestion
- antibiotic prophylaxis
In acute decompensation, general measures such as bed rest, propped up position, humidified oxygen, sodium and, if required, volume restriction are followed routinely. Infants with CHF require 120–150 Kcal/kg/day of intake and 2–3 mEq/kg/day of sodium.¹
Reference
- Jayaprasad N. Heart Failure in Children. Heart Views. 2016 Jul-Sep;17(3):92-99. doi: 10.4103/1995-705X.192556. PMID: 27867456; PMCID: PMC5105230.
Further
Mavrogeni S, Markousis-Mavrogenis G, Papavasiliou A, Kolovou G. Cardiac involvement in Duchenne and Becker muscular dystrophy. World J Cardiol. 2015;7(7):410-414. doi:10.4330/wjc.v7.i7.410.
Rawla P, Padala SA, Ludhwani D. Poststreptococcal Glomerulonephritis. [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538255/.
Sekar RP. Epidemiology of arrhythmias in children. Indian Pacing Electrophysiol J. 2008 May 1;8(Suppl. 1):S8-S13. PMID: 18478058; PMCID: PMC2363719.
