Congestive heart failure (peds)

This page is for pediatric patients. For adult patients, see: congestive heart failure


  • Pediatric congestive heart failure (CHF) affects 12,000-35,000 children in the United States each year[1]
  • The causes and clinical presentation varies differently compared to adults
  • Causes

Clinical Features

  • Symptoms[2]
    • Difficulty breathing
    • Feeding difficulty - irritability with feeding, prolonged feeding time, refusal to feed
      • If an infant has to decide between feeding and breathing, he/she will choose to breathe
    • Sweating with feeds
      • "Exercise intolerance"
    • Failure to thrive
    • Fussiness
    • Older children: fatigue, exercise intolerance, dyspnea, orthopnea, abdominal pain, dependent edema[3]

  • Physical Exam
    • Tachycardia
    • Tachypnea with labored breathing and accessory muscle use
    • Grunting with nasal flaring
    • Rales
    • S3 gallop
    • Hepatomegaly
    • Cyanosis, cool/mottled extremities
    • Decreased capillary refill
    • Edema of face and limbs

Differential Diagnosis



Other diseases with abnormal respiration


  • Blood Work
    • CBC
    • BMP
    • Mg
    • LFT
    • BNP
    • Troponin
    • Blood gas
    • Inflammatory markers such as ESR/CRP if concern for myocarditis, although these are nonspecific
  • EKG
    • Sinus tachycardia - most common
    • May find other etiologies to CHF such as ECG abnormalities pointing towards myocarditis, restrictive cardiomyopathy, heart block, arrhythmias
  • CXR
    • Will help assess for cardiomegaly, pulmonary congestion, interstitial edema, pleural effusions


  • Management tailored to severity of disease
  • Noninvasive ventilation
    • HFNC
    • CPAP
    • BiPAP
  • Diuretics
  • Inotropes/Catecholamines
    • To be used if cardiac function significantly depressed
    • Dopamine (preferred drug for decompensated CHF)
    • Low dose Epinephrine for refractory hypotension
  • Pediatric Cardiology consult


  • In general CHF exacerbation will require admission
  • NICU/PICU if unstable

See Also

External Links


  1. Rossano JW, Kim JJ, Decker JA, et al. Prevalence, morbidity, and mortality of heart failure-related hospitalizations in children in the United States: a population-based study. J Card Fail 2012; 18:459
  2. Judge et al. Congenital Heart Disease In Pediatric Patients: Recognizing The Undiagnosed And Managing Complications In The Emergency Department. Pediatr Emerg Med Pract. 2016. May;13(5):1-28
  3. Jayaprasad. Heart Failure in Children. Heart Views. 2016 Jul-Sep;17(3):92-99