Heart Failure in CHD Flashcards¶
Basic Concepts¶
Q: What is the most common cause of heart failure in children with CHD? A: Systemic ventricular dysfunction (either morphologic LV or RV serving as systemic ventricle) Tags: heart-failure, high-yield, pathophysiology
Q: What are the two main types of heart failure by ejection fraction? A: HFrEF (reduced EF <50%) and HFpEF (preserved EF ≥50%) Tags: heart-failure, classification
Q: What is the Ross Heart Failure Classification used for? A: Grading severity of heart failure in infants (Class I-IV based on feeding, diaphoresis, tachypnea) Tags: heart-failure, ross-classification, high-yield
Q: What defines Ross Class III heart failure? A: Marked tachypnea/diaphoresis with feeds, prolonged feeding times, growth failure Tags: heart-failure, ross-classification
Q: What defines Ross Class IV heart failure? A: Symptoms at rest: tachypnea, retractions, grunting, diaphoresis Tags: heart-failure, ross-classification
Medical Management¶
Q: What is first-line medical therapy for pediatric HFrEF? A: ACE inhibitors (enalapril, captopril, lisinopril) Tags: heart-failure, treatment, high-yield
Q: What beta-blocker has best evidence in pediatric heart failure? A: Carvedilol Tags: heart-failure, treatment
Q: What is the role of digoxin in pediatric heart failure? A: Symptomatic improvement; NOT mortality benefit; low threshold for toxicity Tags: heart-failure, treatment
Q: What diuretic is first-line for volume overload in pediatric HF? A: Furosemide (loop diuretic) Tags: heart-failure, treatment
Q: What is the mechanism of sacubitril/valsartan (Entresto)? A: ARNI - neprilysin inhibitor + ARB; increases natriuretic peptides + blocks RAAS Tags: heart-failure, treatment, mechanism
Q: What lab abnormality indicates worse prognosis in pediatric HF? A: Elevated BNP or NT-proBNP Tags: heart-failure, prognosis, biomarkers
Q: What electrolyte must be monitored closely with aldosterone antagonists? A: Potassium (risk of hyperkalemia) Tags: heart-failure, monitoring
Mechanical Circulatory Support¶
Q: What is the preferred bridge-to-transplant in pediatric patients? A: VAD (ventricular assist device) - better outcomes than ECMO Tags: heart-failure, mcs, high-yield
Q: What percentage of pediatric transplants are now bridged with VAD? A: 36% (increased from 25% in 2010) Tags: heart-failure, mcs, statistics
Q: What are the two main types of VADs used in children? A: Pulsatile (Berlin Heart EXCOR) and continuous flow (HeartMate, HeartWare) Tags: heart-failure, mcs, devices
Q: What is the major complication risk with VADs in children? A: Thromboembolism/stroke (especially with smaller patients) Tags: heart-failure, mcs, complications
Q: When is ECMO preferred over VAD? A: Acute decompensation, biventricular failure, need for rapid deployment Tags: heart-failure, mcs
Q: What INTERMACS profiles typically receive VADs? A: INTERMACS 1-3 (critical cardiogenic shock to stable on inotropes) Tags: heart-failure, mcs, classification
Special Populations¶
Q: What characterizes heart failure in Fontan patients? A: Unique physiology - elevated CVP, low cardiac output, preload dependent Tags: heart-failure, fontan, high-yield
Q: What is the treatment approach for Fontan-associated HF? A: Maintain preload, reduce afterload, consider fenestration, transplant evaluation Tags: heart-failure, fontan, treatment
Q: What causes systemic RV failure in d-TGA after atrial switch? A: Morphologic RV serves as systemic ventricle; progressive dysfunction over decades Tags: heart-failure, chd, tga
Q: What is the treatment for tachycardia-induced cardiomyopathy? A: Rate control or rhythm control of underlying arrhythmia; recovery expected Tags: heart-failure, arrhythmia, reversible
Transplant Indications¶
Q: What are indications for heart transplant listing in children? A: End-stage HF refractory to medical therapy, complex CHD not amenable to surgery, failed Fontan Tags: heart-failure, transplant, high-yield
Q: What is the leading cause of late graft failure post-transplant? A: Cardiac allograft vasculopathy (CAV) Tags: heart-failure, transplant, complications