Pediatric Cardiology Emergencies

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

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

9. Transposition of the Great Arteries

10. TAPVR

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

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

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

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

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

17. Hypoplastic Left Heart

18. Severe Coarctation

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

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

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

23. Narrow Complex Tachycardia

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

25. Complete Heart Block

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

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

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

30. Tetralogy of Fallot

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

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

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

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

36. Congestive Heart Failure • Differing etiology at different ages

37. 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

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

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

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

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

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

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

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

45. Contractility • Chronic Treatment • Digoxin • New Treatments

47. Arrhythmias • Narrow Complex Tachycardias

48. Arrhythmias • Supraventricular Tachycardia

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

50. Wolfe-Parkinson White