NUR117: Infant Heart Failure
NUR117: Infant Heart Failure
11. A nurse is admitting a 4-month-old infant who has heart failure to the cardiac unit. Which of the following findings is the highest priority? (Click on the “Exhibit” button below for additional client information.
ACE inhibitors prevent, attenuate, or possibly reverse the
pathophysiological myocardial remodeling. In addition,
they decrease afterload by antagonizing the rennineangiotensin aldosterone system.28 According to recent
guidelines of The International Society of Heart and Lung
Transplantation on the management of pediatric HF, ACE
inhibitors are recommended in all patients with HF and left
ventricular systolic dysfunction.29 Therapy with ACE inhibitors should be started at low doses with a subsequent
up-titration to the target dose with careful monitoring of
blood pressure, renal function, and serum potassium.
9.5. b blockers-b blockers are now an accepted therapy in the pediatric
population. b blockers antagonize the deleterious effects of
chronic sympathetic myocardial activation and can reverse
left ventricular remodeling and improve systolic function.
Recent reports seem to show that the addition of b blockers
to the standard therapy may be useful in patients with left
ventricular systolic dysfunction.30 In addition, a recent
Cochrane Database of Systematic Reviews on b blockers for
children with congestive HF was published. Seven studies
with a total of 420 children were included in the review and
the authors conclude that the current available data suggest
that children with HF might benefit from b-blocker treatment.31 Low-dose therapy should be started in stable patients with a progressive up-titration to the target dose.
9.6. Inotropes-Digoxin is the main oral inotropic drug used in PHF and is
indicated in symptomatic patients with left and/or right
ventricular systolic dysfunction.32 The use of intravenous
inotropes should be reserved for patients with a severe
reduction of cardiac output resulting in compromised vital
organ perfusion (hypotensive acute/decompensated HF).
Although increased inotropy results in improved cardiac
output and blood pressure, the final result is increased
myocardial oxygen consumption and demand.
The failing myocardium has a limited contractile reserve
and hemodynamic collapse can occur with high-dose
inotropic support in this setting.
9.7. Sympathomimetic amines-Dopamine and dobutamine have been shown to be effective
inotropes and vasopressors in neonates, infants, and children with circulatory failure. These drugs increase cardiac
output and decrease systemic and pulmonary vascular
resistance; however, they can induce tachycardia/tachyarrhythmia with a mismatch between myocardial oxygen
delivery and the requirement.33 Therefore, we reserve the
use of these drugs only for patients with low cardiac output
despite other therapies.