Why is bosom failure in paediatric age group jussive mood. Although bosom failure is more usual in aged people and it is increasing in prevalence and incidence in grownup population1, nevertheless, it is one of the common causes of childhood mortality and morbidity in developing countries2. Pediatric bosom failure is besides economic and societal load, because when a kid takes admittance in infirmary for bosom failure, the economic costs are relatively higher than grownup as it requires repeated demand for surgical based intercession. The stipulated medical attention can scrimmage the household construction and negatively affect parental economic productiveness. If a kid dies of bosom failure, the economic cost is tremendous for the figure of possible productive twelvemonth loss per decease. Therefore, bosom failure in paediatric age group is a grave public wellness concern.

The most common cause of bosom disease among kids is inborn bosom disease. Although, there has been an raising consciousness sing the necessity of early referral of newborn with bosom failure to particular centres and promotion of engineering and preparation in paediatric cardiology and paediatricss in developed states, conversely, in Bangladesh there is still deficiency of consciousness sing paediatric bosom failure make the sensing of inborn bosom disease hard. Incidence of bosom failure due to Arthritic bosom disease is bit by bit cut downing due to allow instances direction and preventative major against Rheumatic fever5 in industrialised states ; nevertheless, it is extensively prevailing in developing states including Bangladesh.

Heart failure has many etiologies. In measuring patients with bosom failure it is of import to place non merely the underlying but besides the precipitating causes. A systemic hunt for the precipitating causes should be made in every patient which will cut down the mortality and morbidity of bosom failure1.

The intent of the survey was to place the hazard factors sing implicit in and precipitating causes of bosom failure, to happen out the relationship between underlying and precipitating cause and eventually to detect the forecast of the hospitalized kids. It may assist to happen out better preventative processs and hence give the affected kids and their parents hope of a better life.

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MATERIALS AND METHODS

This survey is a prospective? ? or instance series survey was carried out over a period of nine months among the admitted kids in the Department of Paediatric and Cardiology section of BSMMU and National Institute of Cardio Vascular Disease ( NICVD ) , located in Dhaka. A entire 60 patients were included in this survey age runing from newborn to 15 old ages with bosom failure. After admittance, elaborate history of the 60 patients was captured for cognizing their clinical presentation. physical scrutiny, probes including X-chest, ECG, echocardiography and blood gas were besides done and daily follow up was given during hospitalization and their result were recorded.

After look intoing, informations were analyzed utilizing the Statistical Package for Social Science ( SPSS ) for Windowss version 11.5. Potential predictive variables were tested for association with the result.

Consequence

The entire figure of patients enduring from Congenital bosom disease was 30 which is ( 50 % ) followed by Arthritic bosom disease ( 33.3 % ) , dilated cardiomyopaty ( 5 % ) , AGN ( 8.3 % ) and anemia ( 3.3 % ) ( table, 1 ) . Out of 30 patient with inborn bosom disease, bulk ( 25 % ) were under 1 twelvemonth of age group followed by ( 16.7 % ) patients were 2 old ages of age group and ( 8.3 % ) patients were found between 3-5 old ages age group ( table, 2 ) . On the other manus, out of 20 patients with arthritic bosom disease, bulk ( 25 % ) were in 11-15 old ages age group followed by ( 8.3 % ) patients were in 6-10 twelvemonth of age group. No patient was found below the age of 6 old ages ( tabular array, 3 ) .

The commonest signifier of inborn bosom disease was VSD ( 30 % ) followed by ASD ( 8.3 % ) and PDA ( 8.3 % ) . 3.3 % of instances had both VSD & A ; ASD. ( table, 4 ) . Among the arthritic bosom diseases, arthritic valvular bosom disease was ( 21.7 % ) , arthritic febrility with carditis was ( 1.6 % ) and ( 10 % ) of patient had both the job ( table, 5 ) .

Major clinical presentations were dysponea ( 100 % ) , weariness ( 93.3 % ) , cough ( 81.7 % ) , growing failure ( 58.3 % ) and repeated chest infection ( 43.3 % ) , Tachycardia ( 95 % ) , tachypnoea ( 93.4 % ) , cardiomegally ( 93.4 % ) , radical crepetation ( 76.7 % ) , hepatomegally ( 98.4 % ) , oedema ( 61.7 % ) . Among them, hepatomegally was the most common marks of bosom failure in this survey ( table, 6 ) . Precipitating factors in bosom failure were non conformity to preventive intervention of arthritic bosom disease ( 35 % ) , malnutrition ( 58.9 % ) , respiratory piece of land infection ( 26.7 % ) and blood poisoning ( 20 % ) and in ( 15 % ) of instances no precipitating factors was identified ( table,7 ) .

The socioeconomic conditions of the patients were divided randomly into three categories: hapless, in-between and rich harmonizing to household income per month. Monthly household income of less than Tk. 3000 was taken as hapless, Tk 3000-6000 as center and above Tk. 6000 as rich. Most of the patients ( 65 % ) were in hapless, ( 26.7 % ) were in in-between and least ( 8.3 % ) were in rich group. ( table,8 ) . Nutritional position of the patient was done by anthopometric measuring. In this survey ( 58.3 % ) of patients were wasted.

The commonest from of valvular disease was mitral regurgitation ( 23.3 % ) ( table, 9 ) .

In this survey, the most common radiological findings of bosom was cardiomegally ( 91.7 % ) followed by hypertrophied left ventricle ( 58.3 % ) , enlarged left atrium ( 55 % ) . However the most common radiological findings of the lung was outstanding vascular marker ( 46.7 % ) so pneumonic venous congestion ( 30 % ) , interstitial hydrops ( 25 % ) and consolidation of lung ( 16.7 % ) . ( table 10 and table 11 ) . The Common ECG findings were sinus tachycardia ( 76.7 % ) , normal axis ( 63.3 % ) , and left ventricular hypertrophy ( 60 % ) ( table 12 ) .

Out of 60 instances, 10 patients had low blood pH, 12 had low hydrogen carbonate and 12 had low carbondioxide.

In this series, ( 13.3 % ) patients were to the full recovered, ( 71.7 % ) had clinical betterment and ( 1 % ) succumbed. Here full recovery means complete remedy, clinical betterment means marks symptoms of the bosom failure has subsided but implicit in diseases were present and complications were cardiogenic daze, septicemic daze and metabolic acidosis ( table 14 ) . On the other manus, ( 10 % ) patients died during the survey period. ( table,15 )

Case human death was equal in both sexes. 3 ( 5 % ) patient died in 2 twelvemonth of age group and 2 ( 2.5 % ) patient in 3 old ages of age group and 1 ( 1.7 % ) patient in 11-15 old ages of age group.

Table aa‚¬ ” II

Congenital bosom disease by age and sex ( n=60 )

Age group

Male

Female

Percentage

& lt ; 1

9

6

25

2

6

4

16.7

3

1

4

8.3

4-5

0

0

0.0

6-10

0

0

0.0

11-15

0

0

0.0

Entire

16

14

50.0

Table-I

Aetiological form of bosom failure ( n=60 )

Aetiology

Number ( % )

Congenital

30 ( 50 % )

Acquired

Arthritic bosom disease

20 ( 33.3 % )

Dilated myocardiopathy

3 ( 5.0 % )

Acute glomerulonephritis

5 ( 8.3 % )

Anaemia ( Thalassaemia )

2 ( 3.3 % )

Table III

Arthritic bosom disease by age and sex ( n=60 )

Age group ( twelvemonth )

Male

Female

Percentage

0-5

0

0

0.0

6-10

2

3

8.3

11-15

8

7

25.0

Entire

10

10

33.3

Table IV

Types of inborn bosom disease ( n=60 )

Congenital bosom disease

Number ( % )

Ventricular septal defect ( VSD )

18 ( 30 % )

Atrial septal defect ( ASD )

5 ( 8.3 % )

Both VSD & A ; ASD

2 ( 3.3 % )

Patent ductus arteriosus ( PDA )

5 ( 8.3 % )

Table V

Types of Rheumatic bosom disease ( n=60 )

Types

Number ( % )

Arthritic febrility with carditis

1 ( 1.6 % )

Arthritic valvular bosom disease

13 ( 21.7 % )

Both

6 ( 10 % )

Table VIII

Socio economic position of the patient ( n=60 )

Socioeconomic position

Number ( % )

Poor

39 ( 65 % )

Middle

16 ( 26.7 % )

Rich

5 ( 8.3 % )

Table VI

Symptoms and marks of bosom failure

Symptoms

Number ( % )

Breathlessness/Dyspnoea

60 ( 100 % )

Cough

49 ( 81.7 % )

Repeated chest infection

26 ( 43.3 % )

Fatigue

56 ( 93.3 % )

Palpitation

21 ( 35 % )

Chest hurting

16 ( 26.7 % )

Growth

35 ( 58.3 % )

Signs

Number ( % )

Tachycardia

57 ( 95 % )

Tachypnoea

56 ( 93.4 % )

Hepatomegally

59 ( 98.4 % )

Basal crepetation

46 ( 76.7 % )

Cardiomegally

56 ( 93.4 % )

Oedema

37 ( 61.7 % )

Table Ten

X-ray findings: Cardiac Shadows ( n=60 )

Findingss

Number ( % )

Normal cardiac shadow

2 ( 3.3 % )

Enlarged right atrium

8 ( 13.3 % )

Enlarged right ventricle

9 ( 15 % )

Enlarged left atrium

33 ( 55 % )

Enlarged left ventricle

35 ( 58.3 % )

Prominent aortal boss

3 ( 5 % )

Full pneumonic conus

18 ( 30 % )

Cardiomegally

55 ( 91.7 % )

Table IX

Pattern of valvular diseases ( n=60 )

Types of valvular disease

Number ( % )

Mitral regurgitation ( MR )

14 ( 23.3 % )

Aortal regurgitation ( AR )

1 ( 1.7 % )

Mitral stricture ( MS )

1 ( 1.7 % )

Both MR & A ; AR

1 ( 1.7 % )

Both MR & A ; MS

2 ( 3.3 % )

Table Eleven

X-Ray findings: Lung Shadows ( n=60 )

Findingss

Number ( % )

Consolidation of right lung

7 ( 11.7 % )

Consolidation of left lung

3 ( 5 % )

Outstanding vascular marker

28 ( 46.7 % )

Pulmonary venous congestion

18 ( 30 % )

Interstitial hydrops

15 ( 25 % )

Non specific determination

1 ( 1.7 % )

Hyper translucence

4 ( 6.7 % )

Increase interstitial markers

4 ( 6.7 % )

Hyperinflation

4 ( 6.7 % )

Pneumatocele of both lung

1 ( 1.7 % )

Pneumonic conus

1 ( 1.7 % )

Table Thirteen

Echocardiography ( n=60 )

Echo findings

Number ( % )

VSD

20 ( 33.3 % )

Pneumonic high blood pressure

35 ( 58.3 % )

ASD

7 ( 11.7 % )

Mitra regurgitation

17 ( 31.7 % )

Personal digital assistant

5 ( 8.3 % )

Aortal regurgitation

2 ( 3.3 % )

Dilated myocardiopathy

3 ( 5 % )

Mitral stricture

3 ( 5 % )

Table Twelve

ECG findings ( n=60 )

Findingss

Number ( % )

Normal tracing

12 ( 20 % )

Sinus tachycardia

46 ( 76 % )

Normal fistula rythum

33 ( 55 % )

Right bundle subdivision block

12 ( 20 % )

Prolonged PR interval

2 ( 3.3 % )

Normal axis

38 ( 68.3 % )

Right axis divergence

7 ( 11.7 % )

Left ventricular hypertrophy

36 ( 60 % )

Right ventricular hypertrophy

8 ( 13.3 % )

Biventricular hypertrophy

2 ( 3.3 % )

Right atrial hypertrophy

1 ( 1.7 % )

Left atrial hypertrophy

3 ( 5 % )

Low electromotive force Electrocardiogram

1 ( 1.7 % )

Tall T moving ridge

1 ( 1.7 % )

Table Fifteen

Diagnosis of decease instances ( n=6 )

Diagnosis

Number ( % )

Heart failure

6 ( 100 % )

Downs syndrome

2 ( 33 % )

VSD

3 ( 50 % )

Blood poisoning

4 ( 66.7 % )

Malnutrition

4 ( 66.7 % )

ASD

2 ( 33.3 % )

Bronchopneumonia

1 ( 16.6 % )

Dilated myocardiopathy

1 ( 16.6 % )

Cardiogenic daze

1 ( 16.6 % )

Table Fourteen

Result of bosom failure ( n=60 )

Result

Number ( % )

Full recovery

8 ( 13.3 % )

Clinical betterment

43 ( 71.7 % )

Other complications

6 ( 10 % )

Death

6 ( 10 % )

Discharge on hazard bond ( DORB )

1 ( 1.7 % )

Table Sixteen

Arterial blood gas analysis of decease instances ( n=6 )

Blood Gas

Number ( % )

pH ( Low )

5 ( 83.3 % )

HCO3 ( Low )

5 ( 83.3 % )

CO2 ( Low )

5 ( 83.3 % )

Discussion

Heart failure is common clinical syndrome and in its advanced phases have a sedate forecast. In this survey 60 patient of bosom failure admitted in pediatric section and cardiology section of BSMMU infirmary and NICVD were included to happen out hazard factors and forecast of bosom failure. Among them ( 50 % ) belonged to inborn bosom disease, arthritic bosom disease was2 ( 33.3 % ) , myocardiopathy was ( 5 % ) and ( 11.6 % ) were non cardiac causes. This determination is consistent with the findings of Herz21. This signifies that bosom failure is more common in both inborn and acquired bosom diseases.

The patients were included below the age of 15 old ages. ( 26.6 % ) patients were below 1 twelvemonth, ( 26.6 % ) were between 11-15 old ages, ( 18.3 % ) were in 2 old ages age group and ( 63.3 % ) patients were in 0-5 yearaa‚¬a„?s age group. This correlative with Smith22 survey, where he showed that ( 87 % ) of bosom failure was 0-5 yearaa‚¬a„?s age group in same survey ( 48.8 % ) were between 6-10 old ages and ( 42.3 % ) were between 11-20 old ages age group. In this survey, ( 51.6 % ) were male affected comparison to ( 48.3 % ) were female. Male preponderance was shown by Smith22. Analysiss of socioeconomic position of the patient of this survey showed bulk were from lower socioeconomic category ( 65 % ) which is similar to the findings from other developing countries24.

In this survey, the hazard factors of malnutrition, down syndrome, respiratory piece of land infection, blood poisoning and cardiogenic daze were identified. Non conformity to drug was found to be an of import precipitating factor in our survey which is common in many studies25, 26.

In this survey inborn bosom disease was found to be the most common cause of bosom failure in early old ages of life. The arthritic bosom disease is the 2nd most common cause of bosom failure in adolescent age group29, 31, and 23. In present survey there was no sex distinction was observed. Sex distribution of arthritic bosom disease tends to differ widely among different survey. The undistinguished difference in the prevalence of arthritic bosom disease by sex was reported in India23. Epidemiologic surveies by Khalil in Saudi Arabia and Sudan have reported higher rates of arthritic bosom disease among females32.

The most common valvular lesion in this survey is mitral regurgitation. Sing the form of valve engagement in present survey of chronic arthritic bosom disease, mitral valve was one the top of the list 88 % , aortal valve was the 2nd in order. Shumpei et Al. showed mitral valve engagement in 80 % , aortice valve in 12 % of cases33. This form of valve engagement besides coincides with assorted surveies from India34,35,36.

It is a heterogenous group of myocardial disease characterized by cardiac dilation and impaired myocardial contractility37. Among 60 patients, 3 ( 5 % ) instances were diagnosed as dilated cardiomyopathhy ( DCM ) belonging to age group of 13-15 old ages. Among them 2 were male and 1 were female, 1 of them died due to cardiogenic daze.

Clinical characteristics are the chief tool to diagnosing of bosom failure. Presentation were usual particular in this survey the most common symptoms of bosom failure were dyspneas, cough of instances, history of repeated chest infections were common in younger age group who had inborn bosom defect. Palpitation weariness and thorax hurting were observed in older kids.

During the survey period ( 10 % ) patients died. Among them ( 8.3 % ) instances bosom failure was due to inborn bosom disease, ( 1.7 % ) patient had dilated cariomyopathy. Among 5 of inborn bosom disease, 2 patient had Down syndrome, malnutrition and septacemia, 2 patient had malnutrition and blood poisoning and 1 patient had bronchopneumonia. Dilated myocardiopathy was associated with cardiogenic daze.

( 13.3 % ) patients were wholly recovered in this survey. ( 71.1 % ) were clinically improved but they need surgical intercession for their complete recovery. 10 patients developed complications during this survey period. Complications were cardiogenic daze, infected daze, arrhythmia, electrolyte instability with acidosis and they were referred to coronary attention unit for specialised attention. 1 patient left infirmary by giving hazard bond ( DORB ) during our survey.

Decision

Congenital bosom disease and arthritic valvular bosom diseases are curable by surgery. Arthritic bosom disease is preventable. Cheap and effortable intervention should be available for such patients. Proper public wellness intercessions are needed to raise consciousness about preventative and healing intervention of different types of bosom diseases.

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