Beruflich Dokumente
Kultur Dokumente
Federico Gómez
Insuficiencia Cardiaca
Ponente: Dr. Luis René Cadena Mejía R4UP
Objetivos
• Definición y Prevalencia
• Etiología y Fisiopatología
• Signos y síntomas
• Diagnósitico y Tratamiento
Insuficiencia Cardiaca
• 2013 CCS Guidelines for HF in children
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Prevalencia
• En los países desarrollados las micardiopatías primarias y las cardiopatías
congénitas son la principal causa en la infancia
GPC Diagnóstico y Tratamiento de la Insuficiencia Cardiaca Aguda y Crónica en niños. SS-186-15 Actualización 2015
Prevalencia
• Los casos de nueva aparición se diagnosticaron el 87% de las veces
durante un evento de descompensación grave
GPC Diagnóstico y Tratamiento de la Insuficiencia Cardiaca Aguda y Crónica en niños. SS-186-15 Actualización 2015
Etiología
• Cardiopatías congénitas
• Miocardiopatías
• Sepsis
• Cardiopatía isquémica
Insuficiencia cardiaca en niños. Carlos Alva. Rev Mex Cardiol 2014; 25 (1): 15-20
Fisiopatología
Insuficiencia Cardiaca
• Disfunción miocárdica
• Aporte inadecuado de oxígeno
y nutrientes
Fuhrman and Zimmerman, Pediatric Critical Care 4th Ed, Chapter 29 Shock States, pp381-395.
Bañuelos- Bustos –Olivar- Cerón –Martínez, Urgencias en Pediatría Hospital Infantil de México, Sexta Edición. Sección IV Estado de Choque y Síndromes Relacionados
Cap. 39 Estado de Choque. Ed. McGraw Hill, pp 216-220
Erin Mandriago MD, Heart Failure in infants and Children, Pediatrics in Review Vol.31 No.1 January 2010
Remodelación Cardiaca
• Cambio de la forma elíptica a una esférica
• Hipertrofia cardiaca
Erin Mandriago MD, Heart Failure in infants and Children, Pediatrics in Review Vol.31 No.1 January 2010
4 mecanismos primarios
• Disfunción sistólica
• Disfunción diastólica
• Mezcla inadecuada
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Disfunción Sistólica
• Hipertrofia concéntrica:
La primera respuesta a una sobrecarga,
donde hay un engrosamiento de las
paredes del VI sin una dilatación de
cámara.
• Hipertrofia excéntrica:
Respuesta más tardía a la presión y al
aumento de volumen, donde la cámara se
agranda y la función sistólica disminuye.
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Erin Mandriago MD, Heart Failure in infants and Children, Pediatrics in Review Vol.31 No.1 January 2010
Anormalidades Celulares
• Disminución en la regulación del receptor Beta 1.
• Apoptosis.
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Anormalidades Celulares
• Disminución en la regulación del receptor Beta 1.
• Apoptosis.
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Fisiopatología
-Beta 1
• Estos receptores permanecen activados
• Apoptosis.
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Sobrecarga ventricular
Remodelación
Ventricular
Hipertrofia Ventricular
Inhibe la
Remodelación
Ventricular
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Anormalidades Celulares
• Disminución en la regulación del receptor Beta 1.
• Apoptosis.
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Ca++
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Ca++
Ca++
Ca++
Ca++
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Ca++
Ca++
Ca++
Receptor
Ca++ Ryanodina (RyR2)
Ca++
Ca++ Ca++
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Receptor
Ryanodina (RyR2)
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Receptor
Ryanodina (RyR2)
Contracción de la fibra
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Receptor
Ryanodina (RyR2)
SERCA2a
SERCA2a
SERCA2a SERCA2a
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Ca++
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Ca++
Insuficiencia Cardiaca
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
B1
Receptor
Ryanodina (RyR2)
SERCA2a
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
B1
Receptor
Ryanodina (RyR2)
• Apoptosis.
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Fisiopatología.
-Apoptosis
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Fisiopatología.
-Disfunción diastólica.
The Pathophysiology of Heart Failure in Children: The Basics. Jarrod D. Knudson. Current Cardiology Reviews, 2016, 12, 99-103
Roger´s Texbook of pediatric intensive care. G. Nichols. Fifth edition. Pag 2040-2060.
Signos y Síntomas
Presentation, Diagnosis, and Medical Management of Heart Failure in Children: Canadian Cardiovascular Society Guidelines, Canadian Journal of Cardiology Volume 29 2013
Presentation, Diagnosis, and Medical Management of Heart Failure in Children: Canadian Cardiovascular Society Guidelines, Canadian Journal of Cardiology Volume 29 2013
Diagnóstico y Evaluación
Radiografía de
Tórax.
• Es un estudio de
primera línea para
la evaluación de la
ICP (Fuerte recomendación, Moderada
calidad de evidencia)
A
• Alta especificidad y B
alto valor
predictivo negativo
Presentation, Diagnosis, and Medical Management of Heart Failure
in Children: Canadian Cardiovascular Society Guidelines. Paul F.
Kantor, MBBCh. Canadian Journal of Cardiology 29 (2013)
1535e1552 C
Laboratorios
• Electrolitos séricos
• Glucosa Se debe realizar en la
• Estado ácido base presentación inicial de
insuficiencia cardiaca y en
• Urea y creatinina evaluaciones posteriores
• Pruebas de función hepática (Fuerte Recomendación, Baja calidad de evidencia)
Presentation, Diagnosis, and Medical Management of Heart Failure in Children: Canadian Cardiovascular Society Guidelines. Paul F. Kantor, MBBCh. Canadian Journal of Cardiology 29 (2013)
1535e1552
Electrocardiograma.
Presentation, Diagnosis, and Medical Management of Heart Failure in Children: Canadian Cardiovascular Society Guidelines. Paul F. Kantor, MBBCh. Canadian Journal of Cardiology 29 (2013)
1535e1552
Ecocardiograma.
D C
Experts’ recommendations for the management of cardiogenic shock in children, Brissaud et al. Ann. Intensive Care (2016) 6:14
Heart failure in children. Part I: clinical evaluation, diagnostic testing, and initial medical management, Paul F. Kantor & Luc L. Mertens Received, Eur J Pediatr (2010) 169:269–279
Metas en cuadro de congestión.
• La meta es llevar al paciente a euvolemia en días o semanas.
Experts’ recommendations for the management of cardiogenic shock in children, Brissaud et al. Ann. Intensive Care (2016) 6:14
Heart failure in children. Part I: clinical evaluation, diagnostic testing, and initial medical management, Paul F. Kantor & Luc L. Mertens Received, Eur J Pediatr (2010) 169:269–279
Agentes inotrópicos.
• No hay estudios controlados para el uso de estos agentes.
• El uso de estos agentes por mas de 48hrs se debe ir destetando este apoyo e ir pensando
en otro tipo de soporte como el trasplante cardiaco.
Experts’ recommendations for the management of cardiogenic shock in children, Brissaud et al. Ann. Intensive Care (2016) 6:14
Heart failure in children. Part I: clinical evaluation, diagnostic testing, and initial medical management, Paul F. Kantor & Luc L. Mertens Received, Eur J Pediatr (2010) 169:269–279
Milrinona.
• Incrementa el índice cardiaco, reduce la presión de los capilares pulmonares, reduce las
resistencias vasculares sistémicas.
Experts’ recommendations for the management of cardiogenic shock in children, Brissaud et al. Ann. Intensive Care (2016) 6:14
Heart failure in children. Part I: clinical evaluation, diagnostic testing, and initial medical management, Paul F. Kantor & Luc L. Mertens Received, Eur J Pediatr (2010) 169:269–279
Vasodilatadores.
Experts’ recommendations for the management of cardiogenic shock in children, Brissaud et al. Ann. Intensive Care (2016) 6:14
Heart failure in children. Part I: clinical evaluation, diagnostic testing, and initial medical management, Paul F. Kantor & Luc L. Mertens Received, Eur J Pediatr (2010) 169:269–279
A B
D C
Experts’ recommendations for the management of cardiogenic shock in children, Brissaud et al. Ann. Intensive Care (2016) 6:14
Heart failure in children. Part I: clinical evaluation, diagnostic testing, and initial medical management, Paul F. Kantor & Luc L. Mertens Received, Eur J Pediatr (2010) 169:269–279