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Neonatal heart failure

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Neonatal heart failure (heart failure) is one of the most common critical illnesses in neonates. The disease develops rapidly, the clinical manifestations are atypical, and the performance of the older children is also very different. It is easy to be confused with other diseases, and it is difficult to diagnose in time. Delaying the disease, it is necessary to raise awareness and vigilance against heart failure, early diagnosis and active treatment.

Cause

Cause

A common cause of heart failure in newborns is critically ill congenital heart disease. Such as complex cyanotic congenital heart disease and large shunt cardiovascular malformations, patent ductus arteriosus in premature infants, myocardial damage after perinatal asphyxia, persistent pulmonary hypertension, severe arrhythmia. It is a cyanotic complex malformation, such as complete transposition of the great aorta, extremely severe tetralogy of Fallot, tricuspid atresia, complete pulmonary venous return, single arterial, left ventricular dysplasia or right dysplasia syndrome.

Examine

an examination

Related inspection

Heart sound map, regression, hot spiral (BR), serous effusion, membranous effusion, proteinuria, cyclic adenosine monophosphate

First, left heart failure symptoms:

(A) difficulty breathing: the most common symptoms of left heart failure. Including labor dyspnea, cough, sitting breathing, paroxysmal nocturnal dyspnea, caused by blood stasis and decreased lung capacity. Patients often wake up during sleep, have a feeling of suffocation, and have frequent coughs.

(2) Cough, cough, hemoptysis: caused by congestion of alveolar and bronchial mucosa, often occurs at night, cough can be relieved when sitting, white serous foamy sputum is characteristic. If the bronchial submucosal dilated blood vessels rupture, it can cause massive hemoptysis.

(3) Others: There may be heart enlargement, fatigue, insomnia, palpitations, oliguria and symptoms of renal dysfunction.

Second, right heart failure symptoms:

(A) upper abdominal fullness: early symptoms of right heart failure, accompanied by loss of appetite, nausea, vomiting, upper abdominal pain.

(B) jugular vein engorgement: a clear sign of right heart failure.

(C) edema: heart failure edema is more common in the lower extremities, showing depression edema, severe cases can spread to the whole body, more than appear or increase in the evening, after a rest of night can be reduced or disappeared.

(4) Purpura: There are many different degrees of purpura in patients with right heart failure.

(5) Neurological symptoms: may have nervousness, insomnia, lethargy and other symptoms.

(6) Cardiac signs: mainly for the original heart disease.

Third, the symptoms of total heart failure:

It is the heart failure caused by right heart failure secondary to left heart failure. When the right heart failure occurs, the right heart discharge is reduced, so the symptoms of pulmonary congestion such as paroxysmal dyspnea are reduced. Dilated cardiomyopathy and other manifestations of left and right ventricular dysfunction, pulmonary congestion is often not very serious, left heart failure is mainly related to the symptoms and signs of cardiac output reduction.

Diagnosis

Differential diagnosis

Differential diagnosis of neonatal heart failure:

First, congenital heart disease

The incidence of neonatal congenital heart disease is 0.6% to 0.8%, which is one of the common causes of neonatal heart failure. The congenital heart disease that can develop heart failure in the neonatal period is mainly cyanotic complex malformation, such as complete transposition of the great aorta, extremely severe tetralogy of Fallot, tricuspid atresia, complete anomalous pulmonary venous return, single artery, Left ventricular dysplasia or right heart dysplasia syndrome. From February 1987 to April 2001, 924 cases of neonatal congenital heart disease were continuously detected by color Doppler echocardiography, including 188 cases of cyanotic heart disease, all of which were complex malformations, and 36 cases of heart failure occurred, accounting for 19%. 5 cases died 4 to 10 days after birth. In recent years, great progress has been made in the diagnosis and treatment of neonatal congenital heart disease, but the condition of congenital heart disease in critically ill newborns is developing rapidly, requiring timely diagnosis and early treatment. Because neonatal heart disease lacks typical symptoms and signs, it is impossible to judge the type of heart disease based on clinical symptoms and signs. Research data show that color Doppler echocardiography can accurately diagnose the type of neonatal congenital heart disease, with clear, safe, non-invasive features, and is of great value in guiding the treatment of neonatal congenital heart disease.

In addition to cyanotic complex congenital heart disease, another type of neonatal critical congenital heart disease is large ventricular septal defect, patent ductus arteriosus, and complete atrioventricular septal defect. These deformities cause a burden of heart function due to a large number of left-to-right shunts. Seriously aggravated, it is prone to heart failure and even death. However, if early intervention can be given and surgery is performed if necessary, a better prognosis can often be obtained.

Second, perinatal asphyxia

More than 50% of heart failure on the first day after birth is due to asphyxia. If not treated promptly, 60% die within three days after birth, which is one of the major causes of perinatal death. Perinatal asphyxia complicated with cardiac damage was first described in 1972 by Rowe et al. using "transient myocardial ischemia", and its main clinical manifestations were summarized as cyanosis, shortness of breath and heart failure. More and more scholars have paid attention to this issue in the future. The literature reports that the incidence of myocardial damage after perinatal asphyxia is as high as 20% to 51%, of which about 9% to 21% of cases develop heart failure.

At the time of asphyxia, myocardial hypoxia-ischemia, causing intracellular acidosis, and reperfusion injury after ischemia, leading to degeneration and necrosis of cardiomyocytes, which is the pathological basis of heart failure after asphyxia. In addition, persistent hypoxemia causes sustained contraction of the pulmonary vascular bed, resulting in increased pulmonary circulation pressure and resistance, increased right ventricular afterload, increased oxygen demand, and endocardial myocardial blood supply is oppressed, thereby aggravating the heart Ischemic myocardium.

Third, sustained pulmonary hypertension

Neonatal persistent pulmonary hypertension, also known as continuous fetal circulation, is caused by a variety of causes, and the pulmonary circulation pressure and resistance of newborns continue to increase after birth, which makes the transition from fetal circulation to normal "adult" type circulation disorder, so that There is a right-to-left shunt at the level of the arterial catheter and the foramen ovale, which leads to severe hypoxemia and bruising. If the treatment is not timely, heart failure can occur, and the previous mortality rate is as high as 50%. In recent years, the combination of comprehensive treatment and new treatment methods such as intravenous infusion of magnesium sulfate or NO inhalation, the occurrence and prognosis of neonatal persistent pulmonary hypertension complicated with heart failure have been greatly improved. The key to successful treatment is early diagnosis and timely treatment.

First, the diagnosis of left heart failure:

(1) Dyspnea: The most common symptoms of left heart failure include labor dyspnea, cough, sitting breathing, and paroxysmal nocturnal dyspnea. It is caused by blood stasis and decreased lung capacity. Patients often wake up during sleep, have a feeling of suffocation, and have frequent coughs.