Differential Diagnosis • Many classes of disorders can result in increased cardiac demand or impaired cardiac function. • Cardiac causes include: - arrhythmias (tachycardia or bradycardia) - structural heart disease - myocardial dysfunction (systolic or diastolic).
Differential Diagnosis • Noncardiac causes of congestive heart failure (CHF) include processes that: - increase the preload (volume overload) - increase the afterload (hypertension) - reduce the oxygen-carrying capacity of the blood (anemia) - or increase demand (sepsis)
Differential Diagnosis • The most likely causes of congestive heart failure depend on the age of the child. • Congestive heart failure in the fetus, or hydrops, can be detected by performing fetal echocardiography.
Differential Diagnosis • Neonates and infants younger than 2 months are the most likely group to present with congestive heart failure related to structural heart disease. • The systemic or pulmonary circulation may depend on the patency of the ductus arteriosus, especially in patients presenting in the first few days of life. In these patients, prompt cardiac evaluation is mandatory. • Myocardial disease due to primary myopathic abnormalities or inborn errors of metabolism must be investigated. • Respiratory illnesses, anemia, and known or suspected infection must be considered and appropriately managed.
Diffrential Diagnosis • In older children, congestive heart failure may be caused by - left-sided obstructive disease (aortic stenosis or coarctation) - myocardial dysfunction (myocarditis or cardiomyopathy) - hypertension - renal failure - arrhythmias or myocardial ischemia.
Differential Diagnosis Illicit drugs such as inhaled cocaine and other stimulants are increasingly precipitating causes of congestive heart failure in adolescents; therefore, an increased suspicion of drug use is warranted in unexplained congestive heart failure. Although congestive heart failure in adolescents can be related to structural heart disease (including complications after surgical palliation or repair), it is usually associated with chronic arrhythmia or acquired heart disease, such as cardiomyopathy.
Differential Diagnosis • Characteristic findings in children with heart failure include the following: • Cardiac rhythm disorders may be caused by the following: • Complete heart block • Supraventricular tachycardia • Ventricular tachycardia • Sinus node dysfunction • Volume overload may be caused by the following: • Structural heart disease (eg, ventricular septal defect, patent ductus arteriosus, aortic or mitral valve regurgitation, complex cardiac lesions) • Anemia • Sepsis
Differential Diagnosis • Pressure overload may be caused by the following: • Structural heart disease (eg, aortic or pulmonary stenosis, aortic coarctation) • Hypertension • Systolic ventricular dysfunction or failure may be caused by the following: • Myocarditis • Dilated cardiomyopathy • Malnutrition • Ischemia • Diastolic ventricular dysfunction or failure may be caused by the following: • Hypertrophic cardiomyopathy • Restrictive cardiomyopathy • Pericardial or cardiac tamponade