Etiology and diagnosis of heart failure in infants and children
- Rakesh K Singh, MD, MS
Rakesh K Singh, MD, MS
- Assistant Professor of Pediatrics
- University of California, San Diego
- TP Singh, MD, MSc
TP Singh, MD, MSc
- Associate Professor of Pediatrics
- Harvard Medical School
In the United States, heart failure-related hospitalization is increasing, and accounts for 14,000 hospitalizations in children [1,2]. In-hospital mortality ranges from 7 to 11 percent [2,3]. The presentation of pediatric heart failure is diverse because of the numerous underlying cardiac etiologies and varying clinical settings (eg, age at presentation).
The etiology, presentation, diagnosis, and initial evaluation of the pediatric patient with heart failure are reviewed here. The management of heart failure in infants and children is discussed separately. (See "Management of heart failure in infants and children".)
Heart failure is a clinical condition that results from impairment of the ventricle to fill with or eject blood. Heart failure is caused by ventricular pump dysfunction, or by overload of volume (preload) or pressure (afterload) [1,4].
PATHOPHYSIOLOGY AND ETIOLOGY
The causes of pediatric heart failure can be divided into pathophysiologic categories (table 1). This categorization helps in the understanding of the underlying physiology and clinical manifestations of the different causes of pediatric heart failure, and guides the approach to management. (See "Management of heart failure in infants and children".)
●Ventricular pump dysfunction − Ventricular dysfunction results in reduced ventricular contractility that leads to impaired ejection of blood from the ventricle. Ventricular dysfunction can occur in both children born with structurally normal hearts and those with congenital heart disease. Children born with a congenital heart lesion may have ventricular pump dysfunction at presentation, but more commonly develop pump dysfunction and heart failure several years (or even decades) following surgical repair of their cardiac defect (ie, “burnt-out” congenital heart disease). (See 'Ventricular pump dysfunction' below.)
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- PATHOPHYSIOLOGY AND ETIOLOGY
- Ventricular pump dysfunction
- - Structurally normal heart
- - Congenital heart disease
- Preserved ventricular pump function with volume overload
- - Cardiac causes
- - Noncardiac causes
- Preserved ventricular pump function with pressure overload
- STAGING AND CLASSIFICATION
- Staging of the progression of HF
- Classification of HF severity
- - NYHA class
- - Ross classification
- - NYU Pediatric HF Index
- CLINICAL MANIFESTATIONS
- Physical examination
- INITIAL EVALUATION
- Chest radiography
- Initial blood tests
- FURTHER EVALUATION
- Magnetic resonance imaging
- Cardiac catheterization
- Additional blood tests
- - Troponin and creatine kinase
- - Inflammatory markers
- - Genetic testing
- - BNP and NT-proBNP
- - Other studies
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS