| What condition is referred to by the abbreviation ALCAPA? | Anomalous Origin of Left Coronary Artery from Pulmonary Artery | Na, Urea and Creatinine Low Risk High-Risk Wean off in 2-3 days Ventilate, Epinephrine Intermediate Consider advanced circulatory support ▶ ▶ ▶ Yes Somewhat No Yes Yes Yes No No improvement No ACEI: Angiotensin Converting Enzyme Inhibitor ALCAPA: Anomalous Origin of Left Coronary Artery from Pulmonary Artery AP Window: Aorto-Pulmonary Window AS: Aortic Stenosis AVCD: Atrio-Ventricular Canal Defect AVCD: Atrio-Ventricular Canal Defect CoA: Coarctation of the Aorta CKMB: Creatine Kinase Myoglobin Binding CRP: C-reactive Protein DCM: Dilated Cardiomyopathy HF: Heart Failure HLH: Hypoplastic Left Heart HR: Heart Rate IE: Infective Endocarditis JVP: Jugular Venous Pressure KD: Kawasaki Disease LV: Left Ventricle MR: Mitral Regurgitation NG: Naso-Gastric PAH: Pulmonary Arterial Hypertension TAPVC: Total Anomalous Pulmonary Venous Connection PDA: Patent Ductus Arteriosus PPV: Positive Pressure Ventilation PS: Pulmonary Stenosis RHD: Rheumatic Heart Disease RR: Respiratory Rate TGA: Transposition of Great Arteries VSD: Ventricular Septal Defect July/ 2024 | 247 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_3_pediatric_heart_failure.pdf | Na, Urea and Creatinine Low Risk High-Risk Wean off in 2-3 days Ventilate, Epinephrine Intermediate Consider advanced circulatory support ▶ ▶ ▶ Yes Somewhat No Yes Yes Yes No No improvement No ACEI: Angiotensin Converting Enzyme Inhibitor ALCAPA: Anomalous Origin of Left Coronary Artery from Pulmonary Artery AP Window: Aorto-Pulmonary Window AS: Aortic Stenosis AVCD: Atrio-Ventricular Canal Defect AVCD: Atrio-Ventricular Canal Defect CoA: Coarctation of the Aorta CKMB: Creatine Kinase Myoglobin Binding CRP: C-reactive Protein DCM: Dilated Cardiomyopathy HF: Heart Failure HLH: Hypoplastic Left | 2 | page=2,block=62 | 0.700 | valid |
| What can hypocalcemia lead to that may result in heart failure? | ventricular dysfunction leading to HF | Essential blood tests to be performed in all Utility Complete blood count; CRP Identifying Sepsis, Anemia Electrolytes and urea, creatinine Elevated urea, creatinine may indicate decompensated HF or may result from medication side effects. Electrolyte imbalance is a common association of HF and diuretic use. Hypocalcemia can cause ventricular dysfunction leading to HF Liver function test Elevated bilirubin, liver enzymes and prolonged prothrombin time points towards congestive hepatopathy. | 333 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_3_pediatric_heart_failure.pdf | Hypocalcemia can cause ventricular dysfunction leading to HF Liver function test Elevated bilirubin, liver enzymes and prolonged prothrombin time points towards congestive hepatopathy. | 2 | page=2,block=17 | 0.700 | valid |
| What does a low level of albumin in the blood suggest about a patient's health? | chronic HF and poor nutrition | Hypoalbuminemia points to chronic HF and poor nutrition Optional tests to be decided based on clinical situation Arterial blood gas with lactate Lactic acidosis- as a marker of tissue perfusion and helps monitor response to treatment; It is also elevated in specific inborn errors of metabolism Thyroid function test Thyroid hormone imbalance could be a primary cause or may lead to worsening of symptoms Brain Natriuretic Peptide (BNP) It helps differentiate HF from respiratory disease. | 26 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_3_pediatric_heart_failure.pdf | Hypoalbuminemia points to chronic HF and poor nutrition Optional tests to be decided based on clinical situation Arterial blood gas with lactate Lactic acidosis- as a marker of tissue perfusion and helps monitor response to treatment; It is also elevated in specific inborn errors of metabolism Thyroid function test Thyroid hormone imbalance could be a primary cause or may lead to worsening of symptoms Brain Natriuretic Peptide (BNP) It helps differentiate HF from respiratory disease. | 2 | page=2,block=17 |
| What is lactic acidosis used to indicate in a medical context? | a marker of tissue perfusion and helps monitor response to treatment | Hypoalbuminemia points to chronic HF and poor nutrition Optional tests to be decided based on clinical situation Arterial blood gas with lactate Lactic acidosis- as a marker of tissue perfusion and helps monitor response to treatment; It is also elevated in specific inborn errors of metabolism Thyroid function test Thyroid hormone imbalance could be a primary cause or may lead to worsening of symptoms Brain Natriuretic Peptide (BNP) It helps differentiate HF from respiratory disease. | 165 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_3_pediatric_heart_failure.pdf | Hypoalbuminemia points to chronic HF and poor nutrition Optional tests to be decided based on clinical situation Arterial blood gas with lactate Lactic acidosis- as a marker of tissue perfusion and helps monitor response to treatment; It is also elevated in specific inborn errors of metabolism Thyroid function test Thyroid hormone imbalance could be a primary cause or may lead to worsening of symptoms Brain Natriuretic Peptide (BNP) It helps differentiate HF from respiratory disease. | 2 |
| What is the purpose of measuring Brain Natriuretic Peptide (BNP) levels? | It helps differentiate HF from respiratory disease. | Hypoalbuminemia points to chronic HF and poor nutrition Optional tests to be decided based on clinical situation Arterial blood gas with lactate Lactic acidosis- as a marker of tissue perfusion and helps monitor response to treatment; It is also elevated in specific inborn errors of metabolism Thyroid function test Thyroid hormone imbalance could be a primary cause or may lead to worsening of symptoms Brain Natriuretic Peptide (BNP) It helps differentiate HF from respiratory disease. | 437 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_3_pediatric_heart_failure.pdf | Hypoalbuminemia points to chronic HF and poor nutrition Optional tests to be decided based on clinical situation Arterial blood gas with lactate Lactic acidosis- as a marker of tissue perfusion and helps monitor response to treatment; It is also elevated in specific inborn errors of metabolism Thyroid function test Thyroid hormone imbalance could be a primary cause or may lead to worsening of symptoms Brain Natriuretic Peptide (BNP) It helps differentiate HF from respiratory disease. | 2 | page=2,block=17 |
| What might high levels of urea and creatinine suggest about a patient's health? | decompensated HF or may result from medication side effects. | Essential blood tests to be performed in all Utility Complete blood count; CRP Identifying Sepsis, Anemia Electrolytes and urea, creatinine Elevated urea, creatinine may indicate decompensated HF or may result from medication side effects. Electrolyte imbalance is a common association of HF and diuretic use. Hypocalcemia can cause ventricular dysfunction leading to HF Liver function test Elevated bilirubin, liver enzymes and prolonged prothrombin time points towards congestive hepatopathy. | 179 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_3_pediatric_heart_failure.pdf | Essential blood tests to be performed in all Utility Complete blood count; CRP Identifying Sepsis, Anemia Electrolytes and urea, creatinine Elevated urea, creatinine may indicate decompensated HF or may result from medication side effects. Electrolyte imbalance is a common association of HF and diuretic use. | 2 | page=2,block=17 | 0.700 | valid |
| What is the recommended course of action for high-risk patients whose symptoms do not improve? | Admit in ICU; I/V Loop diuretic, Inotrope/Vasodilator; ? non invasive PPV | Supplement Ca and Vit D3; ◦Dietary restriction of sodium is generally not recommended in children unless there is severe edema unresponsive to diuretic therapy • Supplementary oxygen ◦May be necessary when there is respiratory distress but must be used with caution in L-R shunts and avoided in neonates with duct dependent lesions General Measures Intermediate-Risk High-Risk LV dysfunction? ACE inhibitor, +/- Beta blockers BNP Normal Na, Urea and Creatinine Admit in ICU; I/V Loop diuretic, Inotrope/Vasodilator; ? non invasive PPV Adequate tissue perfusion: Urine output, Warm extremities, normal lactates Admit in ward; Loop diuretics Are symptoms improved in 2-3 days ▶ ▶ ▶ ▶ ▶ ▶ ▶ ▶ ▶ ▶ ▶ ▶ ▶ ▶ ▶ ▶ ▶ | 461 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_3_pediatric_heart_failure.pdf | Supplement Ca and Vit D3; ◦Dietary restriction of sodium is generally not recommended in children unless there is severe edema unresponsive to diuretic therapy • Supplementary oxygen ◦May be necessary when there is respiratory distress but must be used with caution in L-R shunts and avoided in neonates with duct dependent lesions General Measures Intermediate-Risk High-Risk LV dysfunction? ACE inhibitor, +/- Beta blockers BNP Normal Na, Urea and Creatinine Admit in ICU; I/V Loop diuretic, Inotrope/Vasodilator; ? non invasive PPV Adequate tissue perfusion: Urine output, Warm extremities, |
| What condition is characterized by a malformation of the Vein of Galen? | Vein of Galen malformation | • Duct dependent systemic circulation ◦HLHS ◦Critical AS ◦Critical Co A ◦Interrupted arch • Severe Tricuspid regurgitation • Vein of Galen malformation • Fetal/Neonatal myocarditis • Congenital MR First Week 7-30 Days 3-6 Months 6 Months - 1 Years 1-10 Years • VSD with Coarctation • Large AP window • Persistent truncus arteriosus • Single ventricle physiology with no PS • TGA-VSD/PDA • Large VSD or PDA especially in preterm infants • All cases listed for the first week • Large post tricuspid L-R shunts ◦VSD ◦PDA ◦AV canal defects • ALCAPA • Myocarditis/DCM • All examples listed for the 7-30 days category • Large post tricuspid L-R shunts ◦VSD ◦PDA ◦AV canal defect • Myocarditis/DCM | 125 | definition | 0.940 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_3_pediatric_heart_failure.pdf | • Duct dependent systemic circulation ◦HLHS ◦Critical AS ◦Critical Co A ◦Interrupted arch • Severe Tricuspid regurgitation • Vein of Galen malformation • Fetal/Neonatal myocarditis • Congenital MR First Week 7-30 Days 3-6 Months 6 Months - 1 Years 1-10 Years • VSD with Coarctation • Large AP window • Persistent truncus arteriosus • Single ventricle physiology with no PS • TGA-VSD/PDA • Large VSD or PDA especially in preterm infants • All cases listed for the first week • Large post tricuspid L-R shunts ◦VSD ◦PDA ◦AV canal defects • ALCAPA • Myocarditis/DCM • All examples listed for the 7-30 |
| What condition is characterized by an anomalous left coronary artery originating from the pulmonary artery? | ALCAPA | • Duct dependent systemic circulation ◦HLHS ◦Critical AS ◦Critical Co A ◦Interrupted arch • Severe Tricuspid regurgitation • Vein of Galen malformation • Fetal/Neonatal myocarditis • Congenital MR First Week 7-30 Days 3-6 Months 6 Months - 1 Years 1-10 Years • VSD with Coarctation • Large AP window • Persistent truncus arteriosus • Single ventricle physiology with no PS • TGA-VSD/PDA • Large VSD or PDA especially in preterm infants • All cases listed for the first week • Large post tricuspid L-R shunts ◦VSD ◦PDA ◦AV canal defects • ALCAPA • Myocarditis/DCM • All examples listed for the 7-30 days category • Large post tricuspid L-R shunts ◦VSD ◦PDA ◦AV canal defect • Myocarditis/DCM | 538 | definition | 0.940 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_3_pediatric_heart_failure.pdf | • Duct dependent systemic circulation ◦HLHS ◦Critical AS ◦Critical Co A ◦Interrupted arch • Severe Tricuspid regurgitation • Vein of Galen malformation • Fetal/Neonatal myocarditis • Congenital MR First Week 7-30 Days 3-6 Months 6 Months - 1 Years 1-10 Years • VSD with Coarctation • Large AP window • Persistent truncus arteriosus • Single ventricle physiology with no PS • TGA-VSD/PDA • Large VSD or PDA especially in preterm infants • All cases listed for the first week • Large post tricuspid L-R shunts ◦VSD ◦PDA ◦AV canal defects • ALCAPA • Myocarditis/DCM • All examples listed for the 7-30 |
| What condition is characterized by inflammation of the heart muscle and dilated cardiomyopathy? | Myocarditis/DCM | • Heart valve disease (RHD) • Myocarditis/DCM • Aortoarteritis • Palliated CHD • Post KD coronary arteriopathy • Idiopathic PAH Category Specific Conditions Shunt lesions VSD, PDA, AP window, AVCD, TGA, Truncus, TAPVC Obstructive lesions Critical AS, PS, coarctation/aortic interruption Regurgitant lesions Congenital- AV canal defect, Ebsteins anomaly Acquired- RHD, IE, post-operative Primary Myocardial Dilated cardiomyopathy, Inborn dysfunction errors of metabolism, muscular dystrophy, drug induced Category Specific Conditions Inflammatory Myocarditis and other immunoinflammatory conditions Abnormal rate/rhythm Tachycardiomyopathy, bradycardia, AV dyssynchrony Ischemic Anomalous coronary artery from pulmonary artery, Coronary artery occlusion from other causes Post- cardiac surgery Variety of causes (cardiopulmonary bypass, Myocardial preservation etc.) Abnormal homeostasis Hypoxia, hypocalcemia, hypoglycemia, sepsis, hypothermia | 30 | definition | 0.940 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_3_pediatric_heart_failure.pdf | • Heart valve disease (RHD) • Myocarditis/DCM • Aortoarteritis • Palliated CHD • Post KD coronary arteriopathy • Idiopathic PAH Category Specific Conditions Shunt lesions VSD, PDA, AP window, AVCD, TGA, Truncus, TAPVC Obstructive lesions Critical AS, PS, coarctation/aortic interruption Regurgitant lesions Congenital- AV canal defect, Ebsteins anomaly Acquired- RHD, IE, post-operative Primary Myocardial Dilated cardiomyopathy, Inborn dysfunction errors of metabolism, muscular dystrophy, drug induced Category Specific Conditions Inflammatory Myocarditis and other immunoinflammatory conditions |