Heart failure in infants and children

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Target exams

Red flags

• An infant who becomes increasingly breathless, sweats with feeds and crosses weight centiles downward at four to eight weeks is in pulmonary overcirculation from a left-to-right shunt as the pulmonary vascular resistance falls — assess urgently with echocardiography and start heart-failure therapy
• A previously well child with a viral prodrome who develops tachypnoea, a gallop rhythm and hepatomegaly has acute myocarditis until proven otherwise — this can deteriorate rapidly to cardiogenic shock and needs urgent echocardiography, troponin and a low threshold for intensive care
• A duct-dependent lesion (hypoplastic left heart, critical aortic stenosis, interrupted aortic arch, severe coarctation) collapses when the ductus closes in the first days of life with shock and poor perfusion rather than congestion — start prostaglandin E1 immediately while arranging echocardiography
• Giving indiscriminate high-flow oxygen to an infant with a large left-to-right shunt lowers pulmonary vascular resistance, increases the shunt and can worsen overcirculation failure — titrate oxygen to saturations

Life stages

Care settings

Clinical exam formats

Board mappings

• Heart failure in infants and children
• Heart failure in infants and children: mechanism, modified Ross grading, and management
• Heart failure in infants and children: recognition, acute management, and the carvedilol evidence
• Short case: the infant with tachypnoea and failure to thrive
• Long case: the child with a cardiomyopathy and heart-failure follow-up
• Heart failure in infants and children: classification, pathophysiology, and management
• Cardiac: the infant in heart failure
• Cardiology: heart failure in infants and children
• Patient Care: heart failure in infants and children
• Medical Expert: heart failure in infants and children