Page 23 - Heart Failure Clinical Guidelines

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E. Digoxin
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. Indication for use symptomatic ventricular dysfunction. Digoxin may also be used in
SVT and other arrhythmias with the input of EP.

1. Dosing
a) initial of 5-10mcg/kg/dose in less than <10 years, 2.5-5 mcg/kg/dose in > 10 years, maximum
starting dose of 125mcg
b) target level <1ng/mL
2. Side Effects
nd
st
rd
Heart Block (1 , 2 and 3 degree)
ST segment depression
Atrial Tachycardia
Anxiety
Dizziness
Headache
Blurry or Yellow vision
Vomiting, Nausea, Diarrhea
3. Special Consideration
-digoxin has a low therapeutic index, monitoring for side effects should occur frequently and
include routine ECG evaluation

F. Calcium Channel Blockers (NonDihydropyridines)
The non-dihydroyridines calcium channel blockers act upon the peripheral calcium channels as
well as the calcium channels in the myocardium. In the myocardium, they decrease inotropy and
chronotropy. Therefore, they are typically avoided in pediatric heart failure, but can be utilized in
hypertrophic cardiomyopathy.

1. Dosing
a) initial dose of Diltiazem of 1.5-2mg/kg/day divided q8hrs with max dose of 120mg
b) target dose of Diltiazem of 3.5-4mg/kg/day divided q8hrs with max dose of 480mg
2. Common Side Effects
Dizziness
st
1 degree AV block
Edema
Bradycardia
Hypotension
Vasodilation
3. Special Considerations
-should not be used in patients with WPW
-avoid use in patients with systolic heart failure