Pediatric emergency medicine trisk 1739 1739
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (143.99 KB, 1 trang )
ACUTE HEART FAILURE SYNDROMES
CLINICAL PEARLS AND PITFALLS
In the pediatric population, CHF is most commonly due to CHD.
CHF is often confused with benign respiratory or gastrointestinal
conditions in young children.
Initiation of diuretic therapy promptly in the emergency department has
been shown to decrease length of stay in adults presenting to the ED
with worsening congestive heart failure (CHF).
Current Evidence
AHFS include new onset heart failure or decompensation of chronic heart failure.
In the pediatric population, AHFS are most commonly the sequelae of CHD. Still,
AHFS can also develop in the setting of many inherited and acquired conditions (
Table 86.9 ).
Goal of Treatment
The goal is to identify patients in CHF early in order to initiate diuretic and other
therapy in the ED.
FIGURE 86.11 Torsades de pointes is the rhythm leading to sudden cardiac death in long QT
syndrome.
Clinical Considerations
Clinical Recognition
CHF is notoriously difficult to diagnose in pediatric patients because the chief
complaint is rarely cardiac. Infants and young children typically do not present as
adults with peripheral edema, jugular venous distension, or dyspnea on exertion.
Young patients with CHF present multiple times with nonspecific symptoms
referable to the respiratory or gastrointestinal (GI) system. Infants manifest
feeding difficulties, tachypnea, tachycardia, diaphoresis, hepatomegaly, or
