Hospital pediatrics. Treatment of chronic heart failure in children (most important)

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Hospital pediatrics. Treatment of chronic heart failure in children (most important)

Lecture notes, cheat sheets

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11. Treatment of chronic heart failure in children

Principles of treatment

1. Cardiac glycosides.

2. Diuretics.

3. ACE inhibitors

4.?-blockers.

Tactics for the treatment of chronic heart failure

Stage I - basic therapy of the underlying disease.

Stage IIA - diuretics.

Stage IIB - diuretics, cardiac glycosides.

Stage III - diuretics, cardiac glycosides, peripheral vasodilators.

In stage I, it is necessary to observe the regime of work and rest, moderate physical exercises. In severe stages, physical activity should be limited, bed rest, semi-bed rest is prescribed. A complete, easily digestible food rich in proteins, vitamins, potassium. With a tendency to fluid retention and arterial hypertension, a moderate restriction of sodium chloride is indicated. Cardiac glycosides are prescribed in doses close to the maximum tolerated.

First, a saturating dose is used, then the daily dose is reduced by 1,5-2 times. With glycoside intoxication, unithiol is prescribed (5% solution of 5-20 ml IV, then IM 5 ml 3-4 times a day). According to the indications, antiarrhythmic therapy is carried out. Digoxin is prescribed 2 times a day in tablets of 0,00025 g or parenterally 0,5-1,5 ml of a 0,025% solution (saturation period), then 0,25-0,75 mg (maintenance dose) per day .

The selection of the dosage of cardiac glycosides should be done in a hospital. Diuretics are used for edema, liver enlargement, congestive changes in the lungs. Use the minimum effective dose during treatment with cardiac glycosides.

Hypotaazid is used in tablets of 0,025 g, loop diuretic furosemide or lasix in tablets of 0,04 g or parenterally. Peripheral vasodilators are prescribed in severe cases with the ineffectiveness of cardiac glycosides and diuretics. With stenosis (mitral, aortic), as well as with systolic (blood pressure is reduced from 100 mm Hg and below), they should not be used. Predominantly venous dilators, nitropreparations lower the ventricular filling pressure in case of congestive insufficiency, the arteriolar dilator hydralazine 0,025 g is prescribed 2-3 tablets 3-4 times a day, as well as the calcium antagonist nifedipine, corinfar. Venuloarteriolar vasodilators: captopril at a daily dose of 0,075-0,15 g.

Potassium preparations can be administered together with cardiac glycosides, diuretics and steroid hormones.

It is necessary to ensure the need for potassium through a diet (prunes, dried apricots, apricots, peach, apricot, plum juice with pulp). Potassium chloride is prescribed orally only in a 10% solution of 1 tbsp. l.

Potassium (aldosterone antagonist spironolactone (veroshpiron)) in tablets has a moderate diuretic effect, which manifests itself on the 2nd-5th day of treatment.

Author: Pavlova N.V.

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