Congestive heart failure (peds)

Revision as of 16:15, 25 May 2020 by Rossdonaldson1 (talk | contribs) (Clinical Features)

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

Background

  • 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

Pulmonary/airway

Cardiac

Other diseases with abnormal respiration

Evaluation

  • 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

  • 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

Disposition

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

See Also

External Links

References

  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