Cardiovascular Medicine Book

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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 (e.g. HH6, enterovirus, Parvovirus, Kawasaki's Disease)
      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. See Pediatric Vital Signs
    4. Biventricular failure is the rule
    5. S3 Heart Sound
    6. Tachypnea and other signs respiratory disease
    7. Tachycardia (out of proportion to condition)
    8. Hepatomegaly
    9. Pallor
  6. Labs
    1. Complete Blood Count (CBC)
    2. Brain Natriuretic Peptide (BNP or ntBNP)
    3. Venous Blood Gas
    4. Serum Lactate
    5. Thyroid Stimulating Hormone (TSH)
    6. Serum Troponin
      1. Increased in Myocarditis
      2. ALCAPA (Left Main Coronary Artery Disorder) can predispose to childhood Acute Coronary Syndrome
  7. Imaging
    1. Chest XRay
      1. Pulmonary edema
      2. Cardiomegaly
    2. Bedside Echocardiogram
      1. Decreased cardiac contractility
      2. Cardiac Tamponade
  8. Diagnostics
    1. Electrocardiogram (EKG)
  9. Differential Diagnosis
    1. Neonatal Sepsis
    2. Congenital metabolic conditions
    3. Acute Respiratory Distress Syndrome
  10. Management
    1. Initiate transport to pediatric ICU facility with ECMO capability
    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
      1. Early intubation for increasing respiratory distress
    5. Inotrope support (consult pediatric intensivist)
      1. Dopamine
      2. Dobutamine
      3. Milrinone
    6. Diuretic (if volume overloaded)
      1. Furosemide 1-2 mg/kg IV
    7. Analgesia and sedation
      1. Sedation with Morphine Sulfate 0.05 to 0.1 mg/kg IV
    8. Fluid maintenance
      1. Fluids to 66% of expected fluid maintenance requirement
  11. References
    1. Herndon (2003) AAFP Board Review, Seattle
    2. Claudius, Behar, Salway and Kearl in Herbert (2018) EM:Rap 18(5): 1-3

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