In infancy heart failure is usually secondary to structural heart disease and medical treatment is directed to improving the clinical condition prior to definitive surgery.With modern obstetric management many babies are now discharged from the maternity unit only hours after birth. Therefore babies with serious congenital neonatal heart disease may present to paediatric or Accident and Emergency departments.
Infants with common congenital heart diseases are usually diagnosed in utero or at the post-natal examination but a few will present acutely after discharge from medical care as the lowering pulmonary vascular resistance over the first hours to days of life allows increasing pulmonary flow in infants with left to right shunts such as VSD, persistent PDA, truncus arteriosus. The increasing left to right shunt causes increasing pulmonary congestion and heart failure and the infant presents with poor feeding, sweating and breathlessness. In addition, some may present at a few months of age when heart failure is precipitated by a respiratory infection, usually bronchiolitis.
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