Çocuklarda Konjestif Kalp Yetersizliği

Yıl 2016, Cilt: 10 Sayı: 3, 223 - 232, 01.08.2016

Emine Azak Handan Ünsal Ayşe Esin Kibar İbrahim İlker Çetin

Öz

Konjestif kalp yetersizliği (KKY), kalbin dokuların metabolik gereksinimini karşılayacak miktarda kanı perifere pompalayamaması sonucunda oluşan klinik bir sendromdur. Kalp yetersizliğinin nedenleri ve mekanizmaları açısından yetişkinler ve çocuklar arasında belirgin farklılıklar vardır. Çocuklarda kalp yetersizliği genellikle, konjenital kalp hastalığı ve kardiyomiyopatiden kaynaklanır. Bu nedenler erişkinlerde kalp yetersizliğinden sorumlu olan koroner arter hastalığı ve hipertansiyon gibi nedenlerden önemli ölçüde farklıdır. Çocuklarda kalp yetersizliğinin diğer önemli nedenleri düşük debili kalp yetersizliği yapan kardiyomiyopati ve antrasiklin toksisitesidir. Konjestif kalp yetersizliğinin tanısı öykü, fizik muayene ve ekokardiyografik çalışmalar ile yapılır. Ekokardiyografi en yararlı noninvaziv çalışmadır. Natriüretik peptidlerin plazma düzeyleri, Atriyal Natriüretik Peptid (ANP) ve Beyin natriüretik peptit (BNP) kalp yetersizliği olan hastaların çoğunda artmıştır. Bu peptidlerin plazma seviyeleri yenidoğan ve hayatın ilk haftalarında yüksektir fakat zamanla normal yetişkin düzeylerine düştüğü gözlenir. Bu peptidlerin düzeyinin basınç ve volum yükü artmış kardiyak defektli çocuklarda normal çocuklarda görülen seviyeleri ile karşılaştırıldığında, BNP ve prohormon N-terminali düzeylerinin yüksek olduğu gösterilmiştir. Bununla birlikte çocuklarda kullanılabilecek uygun bir referans aralığı tanımlanmadığından bu peptidlerin kullanılırlığı sınırlıdır. Konjestif kalp yetersizliğinin tedavisi altta yatan ve katkıda bulunan nedenlerin ortadan kaldırılması ile kalp yetmezliğinin kontrolünden oluşur. Kalp yetersizliğine neden olan problemi ortadan kaldırmak mümkün olduğunca en çok arzu edilen bir yaklaşımdır. Klinisyenler olarak pediatrik kalp yetersizliği ile ilgili güncel bilgilere ihtiyacımız vardır. Bu derlemede kapsamlı olarak son yaklaşımlarında dahil olduğu pediatrik kalp yetersizliği tüm yönleriyle anlatılmaktadır.

Anahtar Kelimeler

Çocuklar, Kalp yetersizliği

Congestive Heart Failure in Children

Öz

Cardiac failure is a clinical syndrome where the heart is unable to provide the output required to meet the metabolic demands of the body; however, the causes and mechanisms of cardiac failure are significantly different between adults and children. In children, cardiac failure is most often caused by congenital heart disease and cardiomyopathy. These causes are significantly different from those usually responsible for the conditions in adults, which include coronary artery disease and hypertension. Other significant causes of heart failure in children are cardiomyopathy and anthracycline toxicity, which lead to low‐output cardiac failure. The diagnosis of CHF relies on several sources of clinical findings, including history, physical examination and echocardiographic studies. Echocardiographic studies are the most helpful noninvasive studies. Plasma levels of natriuretic peptides, Atrial Natriuretic Peptide (ANP) and Brain Natriuretic Peptide (BNP), are increased in most patients with heart failure. The plasma levels of these peptides are elevated in the newborn and in the first weeks of life but decrease of the levels observed in normal adults. Increased levels of BNP and the N-terminal of its prohormone have been reported in most children with either pressure or volume overload cardiac lesions compared with the levels seen in normal children. However, the usefulness of the levels of these peptides appears limited because an appropriate reference range has not been established. The treatment of CHF consists of elimination of the underlying causes, treatment of the precipitating or contributing causes, and control of the heart failure state. Eliminating the underlying causes is the most desirable approach whenever possible. That is why clinicians need up-to-date knowledge about pediatric heart failure. The present review comprehensively describes all the aspects of pediatric heart failure including the recent approaches

Anahtar Kelimeler

Children, Heart failure

Kaynakça

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