Congestive heart failure (peds): Difference between revisions

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==Differential Diagnosis==
==Differential Diagnosis==
====Pulmonary/airway====
*Airway obstruction
*[[Anaphylaxis]], [[angioedema]]
*[[Aspirated foreign body]]
*[[Asthma (peds)|Asthma exacerbation]]
*[[Pneumonia (peds)|Pneumonia]]
*[[Pneumothorax]]
*[[Respiratory distress syndrome]]
*[[Meconium aspiration syndrome]]
*[[Bronchiolitis (peds)]], [[URI]]
*[[Pertussis]]
*[[Bronchopulmonary dysplasia]]
*[[Croup]]
*[[Epiglottitis]]
*[[Bacterial tracheitis]]
*[[Tracheomalacia]]
*[[Cystic fibrosis]] exacerbation
*[[Pulmonary edema]]
*[[Pulmonary hypertension]], [[cor pulmonale]]
*[[Inhalation exposure]]
*[[Rib fractures]], [[Flail chest]], [[pulmonary contusion]]
*[[Nonaccidental trauma]]


====Cardiac====
*[[Congenital heart disease]]
*[[Vascular ring]]
*[[Pericardial effusion and tamponade|Cardiac tamponade]]
*[[Myocarditis (peds)]]
====Other diseases with abnormal respiration====
*Normal neonatal periodic breathing (misinterpreted by caregivers as abnormal)
*[[Brief resolved unexplained event]]
*[[Anemia]]
*[[Neonatal abstinence syndrome]]
*Decreased perfusion states
**[[Pediatric shock]]
**[[Sepsis (peds)]]
**[[Dehydration (peds)]]
*[[Metabolic acidosis]]
**[[Diabetic ketoacidosis (peds)]]
**[[Inborn errors of metabolism]]
**[[Salicylate toxicity]]
*[[Carbon monoxide toxicity|CO Poisoning]]
*[[Diaphragm injury]]
*[[Acute kidney injury|Renal Failure]]
*[[Electrolyte abnormalities]]
*[[Fever (Peds)]]


==Evaluation==
==Evaluation==

Revision as of 00:39, 17 May 2020

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

Management

Disposition

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