Please wait while the transcript is being prepared...
0:00
Heart Failure and
Shock in Paediatrics:
Key Indicators and Management.
My name is Hannah
Bellsham-Revell,
and I'm a paediatric
cardiologist at
Evelina London
Children's Hospital.
0:12
Cardiogenic and
hypovolemic shock.
Cardiogenic shock is
where the heart pump
is not working so for
example, a cardiomyopathy.
Hypovolemic shock is where
there is not enough
circulating volume.
For example, blood
loss or sepsis.
Both may present with
tachycardia and hypotension,
and look for associated
features, e.g.,
hepatomegaly may suggest
cardiogenic shock,
or they may have a known
underlying condition
such as haemorrhage,
anaphylaxis, or sepsis
causing hypovolemic shock.
0:43
Cardiac function. Function
that can be measured
on ECG or echo;
electrical function,
mechanical function,
contraction, and relaxation.
Looking at the
left ventricle and
the right ventricle, and
function from a
patient perspective,
can my heart or circulation meet
my metabolic demand at
rest and at stress?
1:04
Electrical function. Is
there normal conduction?
Are there any issues
with conduction?
Is there heart block? Is there
bundle branch block?
Is there dyssynchrony?
Looking at the rhythm, is
it regular or irregular?
Is it sinus or variants,
or are there any tachy-
or bradyarrhythmias?
You need to match the
ECG with a patient.
For example, a patient
in complete heart block,
even with a relatively
low heart block,
may be stable, whereas
a postoperative patient
may not tolerate
even a mild increase
or decrease in heart rate.
1:36
Systolic function.
Myocardial contraction.
This is also tied
to synchrony as
some contraction may occur
after aortic valve closure.
Echo cardiogram can
look at function
subjectively as well
as objective measures,
including M-mode,
TAPSE, or MAPSE,
tissue Doppler, 3D
echo, speckle tracking.
It is important to look at the
whole echo report to gauge
the overall impression, rather
than single parameters
in isolation.
Impaired systolic function can
present with reduced
exercise tolerance,
oedema, breathlessness, and
enlarged heart or hepatomegaly.
What you see on the echo may
not always correlate
with the patient.
Diastolic function.
Myocardial relaxation.
