Page 12 - Heart Failure Guidelines
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Pediatric Heart Failure Guidelines


               The need and type of anticoagulation is stratified based on type of cardiomyopathy, cardiac
               function and, in DCM, presence of central venous catheter (CVL).

                               Function                              Treatment
                   DCM         EF >35%, no CVL                       Aspirin
                               EF < 35% & CVL present                Systemic anticoagulation
                   RCM         Arrhythmia                            Consider Aspirin
                               CVL present                           Systemic anticoagulation
                   LVNC        “Mild” dysfunction                    Aspirin
                               Mod-Severe dysfunction                Systemic anticoagulation
                   HCM         “Mild” dysfunction                    Provider discretion
                               Mod-Severe dysfunction                Provider discretion

               Systemic anticoagulation, when indicated, depends upon the clinical situation with either
               heparin, enoxaparin or warfarin used. See the tables at the end of guideline for initial dosage
               and titration.


               Malnutrition, Poor Growth
                       •  Weight, head circumference (age 3 yrs. and less) and length/height will be
                          documented at each visit
                       •  Weight for age and length/height for age <3  percentile, unintended weight loss, or
                          decrease in z-score of length/height or weight of >1.5 will be referred to dietician for
                          further evaluation and management
                       •  Treatment of poor growth should concentrate on increased caloric intake and
                          treatment of GI symptoms that may decrease caloric intake (reflux, delayed gastric
                          emptying, etc.)

               Metabolic Syndrome
                       •  Patients with BMI >97  percentile obtain lipid panel (HDL, LDL, total serum
                          cholesterol and triglycerides) and HbA1C
                       •  Referral to dietician for education/intervention should occur
                       •  Exercise test performed to determine safety of exercise intervention
                       •  Referral to weight loss program
                       •  Consider endocrinology referral

               Fluid and Salt Restriction
               There are multiple studies indicating that fluid and salt restriction improve congestive symptoms
               in adult patients.  However, the long-term impact on HF outcomes is not yet studied.  There are
               no studies on fluid restriction in pediatric heart failure.  Given that poor growth and cardiac
               cachexia are seen often in pediatric heart failure, fluid restriction may run counter to the need for
               increased caloric intake.  Therefore, a fluid restriction of approximately 2L or 2G of salt can be

               Updated 4/22/2019                                                                      page 12
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