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Abstract Heart failure is significant cause of mortality particularily during the first year of life. When heart failure occurs in the neonatal period it is usually due to stru~tural oongenital heart disease suoh as patent ductus arteriosus, coarctstion of the aorta,ventricular and atrial septal defects, aortic and pulmonary atenosis, Tricuspid regurgitation and transposition of great arteries and total anomalous pulmonary venous return. However, heart failure in the neonate may be due to other causes than structural heart disease which include myocarditis, arrhythmias, glycogen storagedd diseas., snsemia, systemic or pulmonsry hypertension, arteriovenous fistulae, septicaemia, congenital thyrotoxicosis, hypoxemia, hypoglycemia and hypocalcaemia. from the pathophysiologioal point of vi •• the etiologioal factors of heart failure can be classified into J categories . Volume - pressure loading of the myooardium. 2. Primary depression of contraotile element function. J. Arrhythmias. In the neonatal period heart failure give. rise to a distinctive clinical presentation. Common symptoms and signs are feeding diffioultie., tachypnea, tachycardia, pulmonary rales and rhonchi, liver enlargement, and cardiomegaly. Less common manifestations include increase in systemic vanous pressure, peripheral oedema, ascites, pUlsus ulternans, gallop rhythm, and inappropriate sweating. Pleural and perioa.rdisl effusions are very rare. Rapid and accurate diagnosis is a prime importance since the appropriate management is often dependent upon the specific cause. The diagnostic approach should include good history taking, complete physical examination and chest roentgenogram. The electrocardiogram is of little use unless there is an arrhythmia. The echocardiegram and radionuclear angiography represent good non invasive methods of diagnosis, Cardiac catheterization and angiocardiography are mainly valuable preoperative procedures. The mansgement of heart fa·ilure in the newborn rests primarily on the utilization of cardiac glycosides and diuretics. However, surgical intervention may be called when medical measures fail talcontrol adequately the clinical manifestations. |