Pediatric emergency medicine trisk 1740 1740
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cardiomegaly. CHF masquerades as bronchiolitis, asthma, or a lingering common
cold. Older children more frequently present with GI complaints such as
abdominal pain, loss of appetite, and nausea/vomiting. Adolescents with CHF
presenting with abdominal symptoms are most likely to be misdiagnosed.
Common diagnoses made in error are gastroesophageal reflux, gastroenteritis,
hepatitis, or renal failure. CHF should be included on the differential diagnosis of
“dehydrated” patients who do not respond to fluid boluses or patients with
wheezing who do not respond to beta agonists. Consider CHF in the differential
diagnosis of all patients with respiratory and GI symptoms.
Patients with a prior diagnosis of CHF, a neuromuscular disorder, cancer, and
CHD should trigger concern for CHF.
Initial Assessment/H&P. Due to the fact that pediatric patients in CHF do not
present with a chief complaint of CHF, history, physical examination, and testing
should at least consider CHF in every patient with respiratory or GI symptoms.
Key points include inquiry into viral illnesses, family history of
cardiomyopathy, existing or repaired CHD, prior heart failure, heart
transplantation, presence of comorbid conditions including rheumatic heart
disease, hypothyroidism, Kawasaki syndrome, or cancer. One should check
pulses for coarctation of the aorta, auscultate for murmurs/gallop, and palpate the
liver for hepatomegaly as part of every examination. Check for abnormal vital
signs such as tachypnea or tachycardia.
TABLE 86.9
ETIOLOGIES OF ACUTE HEART FAILURE SYNDROMES IN
CHILDREN
Cardiomyopathies
High output states
Cardiovascular disease
Infectious diseases
Medications
Myocarditis, mitochondrial disorders, storage
diseases, metabolic disorders, nutritional
deficiencies
Severe anemia, thyrotoxicosis, AV
malformation
Hypertension, cardiac tumors, congenital heart
disease, coronary artery insufficiency
Septicemia
Chemotherapy
