Skip to content

Cardiomyopathy

SHARE VIA:

Share on facebook
Share on twitter
Share on linkedin
Share on whatsapp

Basic investigation:

ECG, CXR, ECHO, FBE, clotting, UEC  (incl. Ca++, Mg++, Fe++, PO4), CRP, ESR, albumin, LFT, TFT, BNP, troponin I, troponin T, lactate, ABG, VBG.


Extended investigation:

  • Cardiac MRI.
  • 24 hr Holter monitor.
  • Blood: amino acids, carnitine, acyl-carnitine, ammonia, Cu, caeruloplasmin, transferrin ioforms, pyruvate, selenium, vitamins.
  • Urine: amino acids, organic acids, pligosaccharide screen, MPS screen.
  • Autoimmune: ANA, ENA.
  • Genetic: FISH.
  • Endomyocardial biopsy.

Investigation for myocarditis:

  • Blood & Urine for viral cultures (echo, adeno, parvo, coxsackie, CMV, parainfluenza, influenza, HIV, hepatitis screen) and for bacterial (incl. atypical)/fungal/rickettsial/protozoal and helminithic culture.
  • NPA.
  • ETA.

Identifying the high risk patient:

LVEF < 20% or LVEDD >70 mm or increased C/T ratio >0.7 or MR >3 or complex ventricular arrhythmia (NSVT).

All high risk patients require PICU admission !


Acute management guideline for DCM

Is there low perfusion ? Is there congestion ?
NO YES
NO Ward ManagementACEiβ – Blockeroral diuretics PICU admissioniv Frusemide infusionconsider NIV CPAPobserve for minimum of 48 hrwatch BNP & renal function
YES PICU admissionNIV CPAPiv Adrenaline
(max. 0.05 ≈≥g/kg/min)
observe closelyfor need for ECLS
PICU admissioniv Frusemide infusionconsider NIV CPAPintroduce carefully Milrinoneconsider β agonistsobserve for 4 days

 

1. CPAP or BIPAP. Only intubate when ECLS is on stand-by

2. Fluid and water restriction to 25% maintenance

3. Commence IV frusemide infusion. Aim for euvolaemic state in DCM. Mild hypervolaemia may be needed in HCM. Watch renal function. Avoid hypovolaemia.

4. Commence spironolactone (1 mg/kg BD)

5. Commence milrinone if tolerated

6. Commence β-agonists as indicated. Dopamine, dobutamine or adrenaline up to 0.05 mcg/kg/min

7. Consider levosimendan

8. Consider biventricular pacing

9. Consider antiarrhythmic therapy. Consult cardiology. Do not use β-blocker when on β -agonists. β – Blocker might be useful in HCM

10. Consider anticoagulation therapy

11. Ensure appropriate nutrition. Supplemental therapy with carnitine, co-enzyme Q10, vitamins as indicated.

11. Early use of ECLS if patient is deteriorating or not improving (see ECMO)

12. Specific guided therapy in Pompe disease: myozyme


All Marc’s PICU cardiology FOAM can be found on PICU Doctor and can be downloaded as a handy app for free on iPhone or AndroidA list of contributors can be seen here.

About the authors

KEEP READING

High flow therapy – when and how?

Chest compressions in traumatic cardiac arrest

Searching for sepsis

The missing link? Children and transmission of SARS-CoV-2

Don’t Forget the Brain Busters – Round 2

An evidence summary of Paediatric COVID-19 literature

Urticaria

The fidget spinner craze – the good, the bad and the ugly

Parenteral Nutrition

Leave a Reply

Your email address will not be published.

DFTB WORLD

EXPLORE BY TOPIC

We use cookies to give you the best online experience and enable us to deliver the DFTB content you want to see. For more information, read our full privacy policy here.
[cmplz-manage-consent]