Page 11 - Heart Failure Guidelines
P. 11

Pediatric Heart Failure Guidelines

                   •  Side Effects: include dizziness, 1  degree AV block, edema, bradycardia, hypotension
                       & vasodilation.
                   •  Special Considerations: Should not be used in patients with WPW; Avoid use in
                       patients with systolic heart failure


               Digoxin causes inhibition of the sodium/potassium ATPase pump in myocardial cells results in a
               transient increase of intracellular sodium, which in turn promotes calcium influx via the sodium-
               calcium exchange pump leading to increased contractility. May improve baroreflex sensitivity.
               There is retrospective data suggesting improved outcomes in patients between Stage 1 and
               Stage 2 palliation of single ventricles and the post-hoc analysis of prospective data (The Dig
               Trial) showing decreased hospitalization and decreased mortality in patients with lower digoxin
               levels. Controversy continues to exist despite being in clinical use for almost 250 years!

                   •  Indication: include symptomatic ventricular dysfunction. Digoxin may also be used in
                       SVT and other arrhythmias with the input of EP.
                   •  Side Effects: include heart block (1 , 2  and 3  degree), ST segment depression, atrial
                       tachycardia, anxiety, dizziness, headache, blurry or yellow vision, vomiting, nausea, and
                   •  Special Consideration: Digoxin has a low therapeutic index, monitoring for side effects
                       should occur frequently and include routine ECG evaluation. In the setting of suspected
                       or confirmed acute digoxin toxicity, patients may be treated with Digibind (see table).


               Loop (furosemide, bumetanide) and thiazide (Chlorothiazide, Metolazone) diuretics are used to
               treat congestive heart failure.  Adult studies indicate that diuretics do not improve outcomes in
               heart failure.  However they may be helpful in reducing heart failure congestive symptoms.
               Given in combination they act synergistically. Tolvaptan is a vasopressin antagonist and is
               useful when the serum sodium is low.

                   •  Indications: congestive heart failure
                   •  Side Effects: include uremia, hypokalemia, renal Insufficiency, kidney stones.
                   •  Special Considerations: renal insufficiency from spironolactone and ACE-inhibitors can
                       be exacerbated with diuretics

               Updated 4/22/2019                                                                      page 11
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