Ver el código de «Congestive heart failure (peds)»

==Background==
*Pediatric congestive heart failure (CHF) affects 12,000-35,000 children in the United States each year<ref>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</ref>
*The causes and clinical presentation varies differently compared to adults
*Causes
**Structural
***[[Congenital Heart Disease]]
**Acquired
***Arrhythmias
***Cardiomyopathy 
***[[Myocarditis (peds)]]
***Myocardial ischemia (rare)
***Drugs/toxins
***Systemic Lupus Erythematosus

==Clinical Features==
*Symptoms<ref>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</ref>
**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<ref>Jayaprasad. Heart Failure in Children. Heart Views. 2016 Jul-Sep;17(3):92-99</ref>


*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 (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==
*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

*[[Echocardiography]]

==Management==
*Management tailored to severity of disease
*Noninvasive ventilation
**HFNC
**CPAP
**BiPAP
*Diuretics
**[[Furosemide]]
*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==


==See Also==


==External Links==


==References==
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