Cardiovascular Medicine Book


Pediatric Congestive Heart Failure

Aka: Pediatric Congestive Heart Failure, Congestive Heart Failure in Children, CHF in Children
  1. See Also
    1. Congenital Heart Disease
    2. Congenital Heart Disease Causes
    3. Pediatric Murmur
    4. Congestive Heart Failure
  2. Causes: General
    1. See Congenital Heart Disease Causes
    2. Left heart obstructive disease
      1. Hypoplastic Left Heart Syndrome
      2. Aortic Stenosis
      3. Aortic Coarctation
    3. Large shunt with pulmonary overflow
      1. Ventricular Septal Defect
    4. Pump Failure
      1. Myocarditis
      2. Cardiomyopathy
  3. Causes: Age of presentation
    1. Week 1: Hypoplastic Left Heart Syndrome
    2. Week 2: Aortic Coarctation
    3. Week 4-12: Ventricular Septal Defect
    4. After Week 12: Valvular heart disease, Myocarditis
  4. Symptoms
    1. Poor feeding
    2. Diaphoresis with feeding
  5. Signs
    1. See Congenital Heart Disease
    2. See Pediatric Murmur
    3. Biventricular failure is the rule
    4. S3 Heart Sound
    5. Tachypnea and other signs respiratory disease
    6. Tachycardia
    7. Hepatomegaly
    8. Pallor
  6. Differential Diagnosis
    1. Neonatal Sepsis
    2. Congenital metabolic conditions
  7. Management
    1. Initiate transport to pediatric ICU facility
    2. Immediate pediatric Consultation
    3. Oxygen
      1. High Flow Oxygen indicated in most patients
      2. Do not increase FiO2 in hypertrophic left heart
        1. Keep the ductus arteriosus patent
    4. Endotracheal Intubation with ventilations
    5. Digoxin 20 ug/kg IV for 1 dose
    6. Furosemide 1-2 mg/kg IV
    7. Fluids to 66% of expected fluid maintenance requirement
    8. Sedation with Morphine Sulfate 0.05 to 0.1 mg/kg IV
  8. References
    1. Herndon (2003) AAFP Board Review, Seattle

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