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
- Structural
- Acquired
- Arrhythmias
- Cardiomyopathy
- Myocarditis (peds)
- Myocardial ischemia (rare)
- Drugs/toxins
- Systemic Lupus Erythematosus
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
- Airway obstruction
- Anaphylaxis, angioedema
- Aspirated foreign body
- Asthma exacerbation
- 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
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
- Metabolic acidosis
- CO Poisoning
- Diaphragm injury
- Renal Failure
- Electrolyte abnormalities
- Fever (Peds)
Evaluation
Management
Disposition
See Also
External Links
References
- ↑ 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
- ↑ 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
- ↑ Jayaprasad. Heart Failure in Children. Heart Views. 2016 Jul-Sep;17(3):92-99