Case ReportCONGESTIVE HEART FAILURE DUE TO PATENT DUCTUS ARTERIOSUSPresenter:Gheavita Chandra DewiKevin Dilian SugandaSupervisor :dr. Yazid Dimyati, SpAK!INTRODUCTION"eart #ailure"$!o%%urs when the heart %annot deliver ade&uate %ardia% output tomeet the meta'oli% needs o# the 'ody. (n the early stages o# heart #ailure, various%ompensatory me%hanisms are evo)ed to maintain normal meta'oli% #un%tion. *hen theseme%hanisms 'e%ome ine##e%tive, in%reasingly severe %lini%al mani#estations result.+*hen a%hildis admittedtothehospital #or heart #ailure, the%osts are%onsidera'lyhigher #or%hildren than adults 'e%ause o# the #re&uent need #or surgi%al or %atheter,'ased intervention.-hedemandso#medi%al %are%an#raythe#amilystru%tureandadverselya##e%t parentale%onomi% produ%tivity. *hen a %hild dies o# heart #ailure, the e%onomi% impa%t is magni#iedenormously 'e%ause o# the num'er o# potentially produ%tive years lost per death. $or theseand other reasons, heart #ailure in %hildren is a serious pu'li% health %on%ern../eonates and in#ants younger than age . months are the most li)ely group to presentwith %ongestive heart #ailure related to stru%tural heart disease. -he systemi% or pulmonary%ir%ulation may depend on the paten%y o# the du%tus arteriosus, espe%ially in patientspresentinginthe #irst #ewdays o# li#e. (nthese patients, prompt %ardia% evaluationismandatory.0 (n %ase o# %hildren1 this re&uirement in%ludes growth and development. 2nli)e asseeninadults, "$in%hildrenis%ommonlyduetostru%tural heart diseaseandreversi'le%onditions more %ommonly due to volume overload se%ondary to shunt lesions, ando'stru%tive lesions o# the heart, one o# the %ause is PDA.3 -he patient presentation o# patentdu%tus arteriosus PDA! varies widely. Although #re&uently diagnosed in in#ants, thedis%overy o# this %ondition may 'e delayed until %hildhood or even adulthood.(n isolatedpatent du%tus arteriosus PDA!, signs and symptoms are %onsistent with le#t,to,rightshunting.4 1DEFINITION"eart $ailure "$! is a pathophysiologi%al state in whi%h an a'normality o# %ardia%#un%tion is responsi'le #or the #ailure o# the heart to pump 'lood at a rate %ommensurate withthe re&uirements o# the meta'olizing tissues, or does so only at elevated #illing pressures. (n%ase o# %hildren, this re&uirement in%ludes growth and development. -he %urrent Ameri%anCollege o# Cardiology ACC!5 Ameri%an "eart Asso%iation A"A! guidelines de#ine "$ as a%omple6 %lini%al syndrome that %an result #rom any stru%tural or #un%tional %ardia% disorderthat impairs the a'ility o# the ventri%le to #ill with or e7e%t 'lood.3EPIDEMIOLOGY8pidemiology o# heart#ailure inseveral8uropean and . 2Sstudies providesomegeneral in#ormation.-he largest study, using . large data,'ases en%ompassing 49: o# 2Spediatri% age +; years! hospital dis%harges, identi#ied 4: +>:39 tpm, regular.A"do#en: >apid turgor. /ormoperistalti%. Giver, spleen and renal unpalpa'le.$!tre#itie%: Pulse + 4=:.>esult: Cardiomegaly with suspe%ted pneumonia.Cor,i'g Diag'osis@C"$ due to PDA Ioderate P #ailure to thriveMa'age&e't@25, H.+5. l5i with nasal %anule, (D$D D 4: /aCl 9,..4:3 gtt5i mi%ro!, $urosemide . 6 < mg, Spironola)ton . 6 ((,((( linea parasternal de)stra,radiation P! until le#t lower sternal 'order, >>:39 tpm, regular.A'domen >apid turgor. /ormoperistalti%. Giver, spleen and renal unpalpa'le.86tremities Pulse +99 'pm, regular, ade&uate pressure and volume, warm a%ral,C>- Q 0@Genital Iale, within normal limitA C"$ due to moderate PDA P#ailure to thriveP , H.+5. l5i with nasal %anule, (D$D D 4: /aCl 9,..4:3gtt5i mi%ro!, $urosemide . 6 < mg, Spironola)ton . 6 ((,((( linea parasternal de)stra, radiation P! until le#t lower sternal'order, >>:4=tpm, regular,%ra%)les ,5,!,stridor P5P!A'domen >apid turgor. /ormoperistalti%. Giver, spleen, and renal unpalpa'le.86tremities Pulse +4< 'pm, regular, ade&uate pressure and volume, warm a%ral,C>- Q 0@,mus%le hypotrophy,su'%utaneous #at getting thinner, 'aggy pants P!Genital Iale, within normal limitA C"$ due to moderate PDA P IarasmusP #ailure to thrive P suspe%t 'ron%hopneumoniaP , H.+5. l5i with nasal %anule, (D$D D 4: /aCl 9,..4:3gtt5i mi%ro!, $urosemide . 6 < mg, Spironola)ton . 6,. %m".H, Gymph node enlargement ,!.-hora6 Symmetri%al #usi#ormis, inter%ostal spa%e loo)s %learlyP!,Chest retra%tioninter%ostal P!, "> : +09 'pm,reguler, murmur P!%ontinuous murmur grade05< at (C> ((,((( linea parasternal de)stra, radiation P! until le#t lower sternal'order, >>: 49tpm, regular,%ra%)les P5P!,stridor P5P!A'domen >apid turgor. /ormoperistalti%. Giver, spleen and renal unpalpa'le.86tremities Pulse +.4 'pm, regular, ade&uate pressure and volume, warm a%ral,C>- Q 0@,mus%le hypotrophy,su'%utaneous #at getting thinner, 'aggy pants P!Genital Iale, within normal limitA C"$ due to moderate PDA P IarasmusP #ailure to thrive P 'ron%hopneumoniaP , H.+5. l5i with nasal %anule, (D$D D 4: /aCl 9,..4:3gtt5i mi%ro!, $urosemide . 6 < mg, Spironola)ton . 6,. %m".H, Gymph node enlargement ,!.-hora6 Symmetri%al #usi#ormis, inter%ostal spa%e loo)s %learlyP!,Chest retra%tioninter%ostal P!, "> : +09 'pm, reguler, murmur P!%ontinous murmur grade 05((,((( lineaparasternal de)stra, radiationP! until le#t lower sternal'order, >>:39tpm, regular,%ra%)les ,5,!,stridor ,5,!A'domen >apid turgor. /ormoperistalti%. Giver, spleen and renal unpalpa'le.86tremities Pulse +.4 'pm, regular, ade&uate pressure and volume, warm a%ral,C>- Q 0@,mus%le hypotrophy,su'%utaneous #at getting thinner, 'aggy pants P!Genital Iale, within normal limitA C"$ due to moderate PDA P IarasmusP #ailure to thrive P 'ron%hopneumoniaP , H.+5. l5i with nasal %anule, (D$D D 4: /aCl 9,..4:3gtt5i mi%ro!, $urosemide . 6 < mg, Spironola)ton . 6 : +09 'pm, reguler, murmur P!%ontinous murmur grade 05((,((( lineaparasternal de)stra, radiationP! until le#t lower sternal'order, >>: 39tpm, regular,%ra%)les ,5,!,stridor ,5,!A'domen >apid turgor. /ormoperistalti%. Giver, spleen and renal unpalpa'le.86tremities Pulse +.4 'pm, regular, ade&uate pressure and volume, warm a%ral,C>- Q 0@,mus%le hypotrophy,su'%utaneous #at getting thinner, 'aggy pants P!Genital Iale, within normal limitA C"$ due to moderate PDA P IarasmusP #ailure to thrive P 'ron%hopneumoniaP , H.+5. l5i with nasal %anule, (D$D D 4: /aCl 9,..4:3gtt5i mi%ro!, $urosemide . 6 < mg, Spironola)ton . 6((,((( lineaparasternal de)stra, radiationP! until le#t lower sternal'order, >>: 39tpm, regular,%ra%)les ,5,!,stridor ,5,!A'domen >apid turgor. /ormoperistalti%. Giver, spleen and renal unpalpa'le.86tremities Pulse +.4 'pm, regular, ade&uate pressure and volume, warm a%ral,C>- Q 0@,mus%le hypotrophy,su'%utaneous #at getting thinner, 'aggy pants P!Genital Iale, within normal limitC"$ due to moderate PDA P IarasmusP #ailure to thrive P 'ron%hopneumonia, H.+5. l5i with nasal %anule, (D$D D 4: /aCl 9,..4:3gtt5i mi%ro!, $urosemide . 6 < mg, Spironola)ton . 6((,((( lineaparasternal de)stra, radiationP! until le#t lower sternal'order, >>: 39tpm, regular,%ra%)les ,5,!,stridor ,5,!A'domen >apid turgor. /ormoperistalti%. Giver, spleen and renal unpalpa'le.86tremities Pulse +.4 'pm, regular, ade&uate pressure and volume, warm a%ral,C>- Q 0@,mus%le hypotrophy,su'%utaneous #at getting thinner, 'aggy pants P!Genital Iale, within normal limitC"$ due to moderate PDA P IarasmusP #ailure to thrive , H.+5. l5i with nasal %anule, (D$D D 4: /aCl 9,..4:3gtt5i mi%ro!, $urosemide . 6 < mg, Spironola)ton . 6 : +>:39 tpm,regular.35REFFERENCE+. Fernstein, Daniel. "eart $ailure in /elson -e6t'oo) o# Pediatri%s +;th edition./ew Yor). 8lsevier... Daphne -,Gail..99;."eart$ailurein Children:Part(:"istory, 8tiology,andPathophysiology. Cir%ulation "eart $ailure. Ameri%an "eart Assosiation:pg