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Pediatric Cardiology Emergencies
Dr. Zahra Jalili Imam Ali cardiovascular center
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Newborn Problems Cyanosis Low Cardiac Output
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Newborn Problems - Cyanosis
Cardiac Cyanosis Does not respond to oxygen Does not respond to ventilation Usually no respiratory distress
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Newborn Problems - Cyanosis
Evaluation Chest x-ray Arterial blood gasses Echocardiogram
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Newborn Problems - Cyanosis
Right sided obstructive lesions Pulmonary atresia Tricuspid atresia Tetralogy of Fallot
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Tricuspid Atresia
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Newborn Problems - Cyanosis
Abnormal Circulations Transposition of the great arteries Total anomalous pulmonary venous return
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Transposition of the Great Arteries
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TAPVR
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Newborn Problems - Cyanosis
Treatment PGE1 Restoration of acid/base balance Surgical Evaluation
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Newborn Problems - Cyanosis
PGE1 0.1 mcg/kg/min Any intravenous site UAC UVC Peripheral Interosseous
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Newborn Problems Low Cardiac Output
Shock Metabolic acidosis Circulatory shutdown
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Newborn Problems Low Cardiac Output
Evaluation Chest x-ray Arterial blood gasses Echocardiogram Electrocardiogram
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Newborn Problems Low Cardiac Output
Left Sided Obstructive lesions Hypoplastic left heart Critical aortic stenosis Critical coarctation of the aorta
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Hypoplastic Left Heart
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Severe Coarctation
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Newborn Problems Low Cardiac Output
Muscle diseases Myocarditis Cardiomyopathies Sepsis Asphyxia
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Newborn Problems Low Cardiac Output
Heart Rate Problems Supraventricular tachycardias Complete heart block
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Newborn Problems Low Cardiac Output
Supraventricular Tachycardia Narrow Complex Heart Rate > 220 bpm Usually > 240 bpm
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Narrow Complex Tachycardia
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Newborn Problems Low Cardiac Output
Complete Heart Block Heart rate below 60 bpm No relationship between P waves and QRS’s
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Complete Heart Block
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Newborn Problems Treatment Left heart obstructive lesions
Muscle diseases Heart rate problems PGE1 Inotropic support and afterload reduction Slow down or speed up
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Infant and Childhood Problems
Hypercyanotic spells Congestive heart failure Arrhythmias
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Infant and Childhood Problems
Hypercyanotic Spells Tetralogy of Fallot Pulmonary Atresia
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Tetralogy of Fallot
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Infant and Childhood Problems
Hypercyanotic Spells Sudden decrease in pulmonary blood flow, usually in the morning Provocation
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Hypercyanotic Spells Treatment Calming Oxygen Morphine Beta Blocker
Phenylepherine
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Hypercyanotic Spells Phenylepherine
Increase systemic vascular resistance which leads to less R - > L shunting and improved saturation
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Hypercyanotic Spells Long Term Treatment with Propranolol
Indication for surgery, either palliative shunt or total repair
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Congestive Heart Failure
Differing etiology at different ages
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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
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Congestive Heart Failure
Presentation after infancy Progression of structural heart disease Arrhythmias Infectious diseases Later onset myopathies Toxins: Anthracyclines Diphtheria
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Congestive Heart Failure
Pre-load Contractility Heart Rate Determinants of Cardiac Output Afterload
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Congestive Heart Failure
Preload reduction Diuretics Fluid Restriction High caloric density
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Congestive Heart Failure
Afterload reduction ACE inhibitors Nitroprusside
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Congestive Heart Failure
Heart Rate modification Beta Blockers Also treats diastolic dysfunction
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Contractility Acute Treatment Beta Agonists Dopamine
Dobutamine Afterload reduction also Epinepherine Dopamine Increased myocardial demands Milrinone
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Contractility Milrinone increases contractility and reduces afterload without increasing myocardial oxygen demand
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Contractility Chronic Treatment Digoxin New Treatments
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Arrhythmias Narrow Complex Tachycardias
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Arrhythmias Supraventricular Tachycardia
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Arrhythmias Re-entrant Tachycardias AV node re-entry
Wolfe-Parkinson-White
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Wolfe-Parkinson White
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Arrhythmias Treatment Pre-hospitalization Diving reflex Valsalva
Ice Bag to the face Valsalva Carotid Massage
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Arrhythmias Hospitalization Adenosine Diagnostic and therapeutic
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Arrhythmias Adenosine 100 mcg/kg IV rapid push
Repeat every 5 minutes with increasing doses
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Arrhythmias Shock requires Shock Synchronized cardioversion 1 joule/kg
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Arrhythmias If adenosine fails: Calcium Channel blockers
Not in infants!
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Arrhythmias Digoxin Loading Procainamide loading Repeat adenosine
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Ventricular Tachycardia
Image 3 Ventricular Tachycardia
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Wide Complex Tachycardias
Treat all as if Ventricular Tachycardia
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Wide Complex Tachycardias
Unstable rhythm requires Cardioversion 2 joules/kg
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Ventricular Fibrillation
Image 4 Ventricular Fibrillation
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Wide Complex Tachycardias
Medical therapy Lidocaine Amiodarone
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Wide Complex Tachycardias
Surgical Therapy Automatic Implantable Cardioverter-Defibrillator
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Thank You
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