Heart failure in infants

Nowadays, many children may have to go through the gates of hell after they are born. Parents all hope that their children are healthy, and they feel very uncomfortable when they see their children need treatment. In fact, the baby's heart rate will be abnormal, because after heart failure occurs, the heart rate function will decrease and the heart rate function will be uneven.

The heart rate should increase during acute heart failure, so why did this patient's heart rate slow down instead?

Clinical abnormalities, once contradictory, often indicate bigger problems.

For example, "bile enzyme separation" indicates more serious liver failure. "Relatively slow pulse", fever and heart rate do not increase significantly. In addition to typhoid fever, it is also seen in myocarditis and conduction system involvement.

There is also a group of contradictory conditions that are common in clinical practice but have not received enough attention, namely acute heart failure with bradycardia.

In acute heart failure, the heart rate should increase compensatorily. When will the heart rate slow down instead? In this case, there is often a bigger problem hidden besides heart failure, which requires careful differential diagnosis. The following is an illustration of a clinical case.

Medical history review

The emergency department sent out a car to pick up a patient, a 69-year-old woman who had been suffering from shortness of breath for 3 days, which had worsened for 1 day and she could not lie flat. The emergency doctor considered the possibility of "acute heart failure" and called for a consultation.

Physical examination: R28 times/min, blood pressure 152/82 mmHg. Drowsiness, lying in a high-pillow position, unable to speak, obvious sweating, HR45bpm, heart sounds not significantly weakened, no obvious pathological murmurs in the auscultation areas of the valves. There are a lot of dry and wet rales in both lungs. Mild edema of both lower limbs.

Oxygen inhalation through mask (8L/min), SpO295%. ECG: atrial fibrillation with slow ventricular rate.

In this case, there should be no problem considering heart failure. You can first give furosemide 40mgiv; nitroglycerin can be pumped in to dilate blood vessels and control blood pressure; if the heart rate is slow, cedilanid is not needed.

Emergency check indicators can also be routine: NT-proBNP, troponin, CKMB, electrolytes, creatinine, glucose, blood gas, and routine blood tests.

However, if acute heart failure is combined with a slow heart rate, we must be vigilant, as there must be a reason for the contradiction.

Case Analysis

To find out the real cause of this patient's illness, you can start with the medical history and try to clarify the following questions. The patient was unable to speak and could only turn to his family and old outpatient medical records for help.

1. Previously diagnosed diseases

From the outpatient medical records, we can see that the patient had a history of diabetes and hypertension, but no history of chronic obstructive pulmonary disease, which further supports the view that shortness of breath may be caused by coronary heart disease and heart failure, rather than pulmonary reasons. Sleepiness is the second contradiction in this patient. Generally, patients with acute heart failure are in a state of stress.