Diagnosis and Management of Pediatric Heart Failure

Missed or Delayed Diagnosis of Heart Disease by the General Pediatrician

Missed or delayed heart disease diagnoses pose a major challenge in pediatric primary care. Many cardiac conditions present with subtle or nonspecific symptoms that resemble benign childhood illnesses, making their prompt recognition difficult. This review describes congenital and acquired heart diseases prone to diagnostic delays, including critical congenital heart disease, coarctation of the aorta, atrial and ventricular septal defects, myocarditis, Kawasaki disease, heart failure, and pulmonary arterial hypertension. The atypical presentations of these disorders and the associated diagnostic pitfalls are emphasized. Furthermore, the importance of alarming symptoms and signs, such as chest pain, palpitations, syncope, and abnormal heart murmurs, is underscored. A structured approach to these red flags is presented to assist primary care pediatricians in identifying children at risk, initiating appropriate management, and referring them for specialized evaluation. The importance of preparticipation screening for athletes is also discussed, highlighting how it can be applied to all children during routine health visits to identify those with heart disease. Appropriate training is essential to increase pediatricians' ability to recognize and manage cardiac patients.

The effect of high-fiber diet based on gut microbiota in patients with chronic heart failure

This research explored the effect of a high-fiber diet based on gut microbiota on patients with chronic heart failure (HF). Patients with chronic HF, who had undergone a dietary survey indicating a daily dietary fiber intake of less than 15 g/day, were divided into the control and study groups (n = 50). In addition to conventional heart failure treatment, the study group received dietary guidance, while the control group did not receive any dietary guidance and maintained their usual low-fiber dietary habits. After 1 yr intervention, the daily dietary fiber intake, abundance of gut microbiota, plasma trimethylamine N-oxide (TMAO), albumin (ALB), prealbumin (PA), transferrin (TF), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), left ventricular ejection fraction (LVEF), left ventricular end-diastolic index (LVEDVI), and left ventricular end-systolic volume index (LVESVI), Barthel index (BI), and 6 min walking distance (6 MWD) were compared. After the intervention, in both groups, the daily dietary fiber intake increased and the abundance of Firmicutes, Proteobacteria, Actinobacteria, and Fusobacteria decreased and that of Bacteroides increased; the plasma TMAO decreased; serum ALB, PA, and TF levels increased; serum CRP, TNF-α, IL-6, and IL-8 levels decreased, and the change was greater in the study group; LVEF elevated, LVEDVI and LVESVI reduced, and the differences between both groups were not significant; BI and 6 MWD elevated, and the study group was higher than the control group. High-fiber diet positively regulates the composition of gut microbiota, nutritional status, and microinflammatory level in patients with chronic HF, thereby improving patients' quality of life.NEW & NOTEWORTHY Traditional heart failure (HF) treatment primarily focuses on medications and surgery, whereas this study explores the improvement effects of a diet high in dietary fiber on patients with chronic HF from the perspective of gut microbiota, providing a new perspective for HF treatment.

Multi-residual 2D network integrating spatial correlation for whole heart segmentation

Whole heart segmentation (WHS) has significant clinical value for cardiac anatomy, modeling, and analysis of cardiac function. This study aims to address the WHS accuracy on cardiac CT images, as well as the fast inference speed and low graphics processing unit (GPU) memory consumption required by practical clinical applications. Thus, we propose a multi-residual two-dimensional (2D) network integrating spatial correlation for WHS. The network performs slice-by-slice segmentation on three-dimensional cardiac CT images in a 2D encoder-decoder manner. In the network, a convolutional long short-term memory skip connection module is designed to perform spatial correlation feature extraction on the feature maps at different resolutions extracted by the sub-modules of the pre-trained ResNet-based encoder. Moreover, a decoder based on the multi-residual module is designed to analyze the extracted features from the perspectives of multi-scale and channel attention, thereby accurately delineating the various substructures of the heart. The proposed method is verified on a dataset of the multi-modality WHS challenge, an in-house WHS dataset, and a dataset of the abdominal organ segmentation challenge. The dice, Jaccard, average symmetric surface distance, Hausdorff distance, inference time, and maximum GPU memory of the WHS are 0.914, 0.843, 1.066 mm, 15.778 mm, 9.535 s, and 1905 MB, respectively. The proposed network has high accuracy, fast inference speed, minimal GPU memory consumption, strong robustness, and good generalization. It can be deployed to clinical practical applications for WHS and can be effectively extended and applied to other multi-organ segmentation fields. The source code is publicly available at https://github.com/nancy1984yan/MultiResNet-SC.

Family management experience of parents of children with chronic heart failure: A qualitative study

PURPOSE

To explore the experience of family management among parents of children with chronic heart failure.

DESIGN AND METHODS

Qualitative descriptive phenomenology was used as the research design. The sample included 16 parents. For data collection, semi-structured interviews were conducted. Colaizzi's seven-step analysis method was used for data analysis. Themes were encoded and created with Nvivo 12.0 Plus software.

RESULTS

Three themes and ten sub-themes were identified: (1) weakened family socialization (diminished parental role in social education and insufficient socialization of children), (2) experience of five psychological stages (resistance, self-blame, worry, exhaustion, acceptance), and (3) family management dilemmas (low social awareness of the disease, heavy economic burden, and limited coping style).

CONCLUSION

The experience of parents of children with chronic heart failure is complex. The children have low socialization and face public prejudice. Parents are stressed by social education, economics, and the five psychological stages they have experienced. Families face difficulties such as heavy economic burdens and limited coping styles.

PRACTICE IMPLICATIONS

To address these complexities, pediatric nursing staff should take steps to improve family management and, as a result, children's quality of life. Our study provides a resource for pediatric nursing staff when implementing family management interventions.