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Related Concept Videos

Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

1.5K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Heart Failure I: Introduction01:27

Heart Failure I: Introduction

2
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
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Heart Failure V: Nursing Interventions01:30

Heart Failure V: Nursing Interventions

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The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
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Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

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Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
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Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

3
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Aortic Regurgitation IV: Nursing Management01:17

Aortic Regurgitation IV: Nursing Management

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A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
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Wireless Telemetry Device Implantation in a Fontan Ovine Model for Continuous and Long-Term Hemodynamic Monitoring
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Identifying Frailty and Its Risk Factors in Pediatric Patients with Fontan Physiology.

Megan M Wilde1, Kurt R Schumacher2, Sunkyung Yu2

  • 1Division of Pediatric Cardiology, Department of Pediatrics, Indiana University, Indianapolis, IN, USA.

Pediatric Cardiology
|October 4, 2024
PubMed
Summary

One-third of pediatric patients with Fontan circulation are frail, experiencing reduced physical function and increased hospitalizations. Frailty in these young patients is often unrecognized by healthcare providers, necessitating improved screening.

Keywords:
Congenital heart diseaseFontanFrailtyPediatric

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Area of Science:

  • Pediatric Cardiology
  • Gerontology
  • Clinical Medicine

Background:

  • Frailty is a recognized syndrome in adults, linked to adverse health outcomes.
  • Its prevalence and impact in pediatric populations, particularly those with single-ventricle heart disease, remain understudied.
  • The Fontan circulation presents unique physiological challenges that may influence frailty development in children.

Purpose of the Study:

  • To determine the prevalence of frailty in pediatric patients with Fontan circulation.
  • To identify risk factors associated with frailty in this cohort.
  • To compare objective frailty assessments with provider estimations and assess impact on quality of life.

Main Methods:

  • A single-center, prospective cohort study involving 54 pediatric patients (10-21 years) post-Fontan palliation.
  • Utilized a modified Fried frailty assessment measuring slowness, weakness, exhaustion, shrinkage, and physical activity.
  • Assessed patient-reported quality of life (QOL) and compared frailty scores with provider estimates.

Main Results:

  • 33% of patients were identified as frail, and 48% as pre-frail.
  • Common frailty domains included slowness (93%), weakness (41%), and diminished physical activity (39%).
  • Frail patients had significantly lower physical functioning scores (PedsQL) and associations with protein-losing enteropathy and recent hospitalization.

Conclusions:

  • Frailty is prevalent in pediatric patients with Fontan circulation, impacting physical function and healthcare utilization.
  • Provider recognition of frailty was poor, highlighting a gap in clinical assessment.
  • There is a critical need for enhanced screening and targeted support for frailty in this vulnerable pediatric population.