Heart Failure, Maintenance Therapy
General and supportive measures Medicine treatment Referral ICD-10 code: I50.9 GENERAL AND SUPPORTIVE MEASURES Recognise and treat the underlying condition, e.g. infection, hypertension, cardiac tamponade, fluid overload. Fluid restriction (75% of daily requirements) – but not at the expense of adequate caloric intake. Ensure adequate nutrition; tube-feeding may be necessary. Monitor blood
General and supportive measures
Medicine treatment
Referral
ICD-10 code: I50.9
GENERAL AND SUPPORTIVE MEASURES
- Recognise and treat the underlying condition, e.g. infection, hypertension, cardiac tamponade, fluid overload.
- Fluid restriction (75% of daily requirements) – but not at the expense of adequate caloric intake.
- Ensure adequate nutrition; tube-feeding may be necessary.
- Monitor blood potassium levels, urea and electrolytes.
MEDICINE TREATMENT
- Oxygen 100%, administered via face mask or nasal cannula.
Combination drug therapy is usually indicated, i.e. start with a diuretic, then add an ACE-inhibitor.
Diuretic therapy
- Furosemide, oral, 1–2 mg/kg/dose 12 hourly. Titrate dose against clinical response. Potassium supplements are necessary if furosemide is used without an aldosterone antagonist, i.e. spironolactone.
- Monitor for response.
If response still inadequate, consider:
- Hydrochlorothiazide 1 mg/kg/dose oral, 12 hourly in consultation with a paediatric cardiologist.
AND
ACE-inhibitor
Note: ACE-inhibitors are contraindicated in bilateral renal artery stenosis, coarctation of the aorta, aortic stenosis and mitral stenosis.
- Captopril, oral:
- Initial dose: 0.5–1 mg/kg/24 hours in 3 divided doses (8 hourly) for 24– 48 hours.
- Increase by 0.5 mg/kg/24 hours every 24–48 hours until maintenance dose of 3–5 mg/kg/24 hours is reached. If < 1 year do not exceed 4 mg/kg/day.
- Continue as long as needed to control the cardiac failure and allow myocardial recovery.
OR
- Enalapril, oral, 0.2–1 mg/kg/day as a single dose or 2 divided doses. Start at the low dose and increase by 0.2 mg/kg/day at 1–2 day intervals.
In still symptomatic add:
- Spironolactone, oral, 1–3 mg/kg/dose once daily. May be divided 12 hourly.
In those patients that are refractory, refer to a paediatric cardiologist for consideration of beta-blockers and digoxin.
REFERRAL
- For determination of the underlying cause where this is not known, and review of treatment after stabilisation.
- Deterioration despite adequate treatment.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 4: Cardiovascular System , 4.9 Heart Failure, 4.9.2 Heart Failure, Maintenance Therapy