Paediatrics: Circulation: cardiovascular difficulty

Circulation: cardiovascular difficulty

Shock

The failure to deliver adequate oxygen to the tissues:

·Heart rate disturbance: bradycardia, dysrhythmias.

·Decreased stroke volume: hypovolaemia; vasodilatation; poor contractility.

Congestive heart failure

Cardiac fatigue due to:

·Excess volume load: from left-to-right cardiac lesions (ventricular septal defect (VSD), patent ductus arteriosus (PDA), atreriovenous (AV) canal), AV fistula, severe anaemia, hypervolaemia.

·Excess pressure load: from systemic vascular system (aortic stenosis, coarctation  of the aorta, or hypertension) or pulmonary vascular system (pulmonary stenosis, pulmonary hypertension, chronic hypoventilation, or severe upper airway obstruction).

·Myocardial problems: including cardiomyopathy, myocarditis, myocardial ischaemia (anomalous coronary artery, cardiac thrombosis in Kawasaki), metabolic disorders.

·Excess myocardial demand: due to fever, thyrotoxicosis.

Dysrhythmia

uncommon, but consider:

·Supraventricular tachycardia.

·Congenital heart block.

Hypertension

causes of hypertension are:

·Renal: glomerulonephritis; haemolytic–uraemic syndrome; pyelonephritis; obstructive nephropathy; vascular disease.

·Cardiac: coartation of the aorta.

·Neurological: infection; drugs; tumour; cerebral oedema.

·Endocrine: phaeochromocytoma; Cushing’s syndrome; corticosteroids; hyperthyroidism.

·Toxins and poisons.

·Primary essential hypertension.

Anaphylactic shock

main causes are food, medication, and insect bites. Life-threatening problems are:

·Respiratory: airway narrowing of upper and lower airway.

·CVS: shock, vasodilatation, and increased vascular permeability.

Pericarditis 

The causes include infection, rheumatologi-cal disorders, trauma, malignancy, and post-pericardiotomy syndrome.

Congenital heart disease