Congestive heart failure in childhood: diagnostics and treatment [Article in Bosnian]

Congestive heart failure occurs when the heart can no longer meet the metabolic demands of the body under normal physiologic venous pressures. The evolution and progression of congestive heart failure is a result of the mutual interaction of complex haemodinamic neurohormonal, cells and genetic factors. Decreased cardiac output is a consequence of complex interaction factors. Systolic dysfunction, which occurs in congestive heart failure, is characterized by diminished ventricular contractility, resulting in decreased ability to increase the stroke volume to meet systemic demands. Diastolic dysfunction results from decreased ventricular compliance, necessitating an increase in venous pressure to maintain adequate ventricular filling. The most frequent causes of cardiac insufficiency in children are congenital structural heart anomalies and genetic, metabolic defects of heat muscles. The signs of congestive heart failure vary with the child’s age, they include apart from tachycardia: a high level of cathemolamins, venous congestion and insufficient cardiac output. Diagnosis is made upon history taking, physical examination, laboratory tests, x ray diagnostics, electrocardiography and echocardiography. The management of CHF is difficult and sometimes dangerous without knowledge of the underlying cause. Consequently, the first priority is acquiring a good understanding of the aetiology. The goals of medical therapy are reducing the preload, enhancing cardiac contractility, reducing afterload, improving oxygen delivery and enhancing nutrition. Up to date medicament therapy includes: inotropc drugs, inhibitors fosfodiesteraze, diuretics, ACE inhibitors, digitalis, beta blockers and vasodilatators. The treatment of CHF due to the various kinds of causes should be created individually to each patient’s demands and be monitored.