Page 7 - Heart Failure Guidelines
P. 7

Pediatric Heart Failure Guidelines

                                                Symptom Severity Classification
                  Class   NYHA                                      Ross
                    I    No limitations of physical activity        No limitations or symptoms
                    II   May experience fatigue, palpitations, dyspnea, or   Mild tachypnea or diaphoresis with feeding
                         angina during moderate exercise but not during
                         rest
                   III   Symptoms with minimal exertion that interfere with   Infants with growth failure and marked
                         normal daily activity                      tachypnea or diaphoresis with feedings, older
                                                                    children with marked dyspnea on exertion
                   IV    Unable to carry out any physical activity as they   Symptoms at rest such as tachypnea,
                         typically have symptoms of heart failure at rest that   retractions, grunting, or diaphoresis
                         worsens with any exertion

               Initial Tests

                   Imaging
                         CXR (PA & LAT)
                         Echocardiogram
                         CMR (cardiac MRI) - standard when patients do not require sedation

                   Rhythm
                         ECG
                         Exercise Test with Metabolic Cart (approximately age 8yo and greater)
                         Holter Monitor
                         Event Monitor (if palpitations, syncope)

                   Laboratories
                         CBC with Diff
                         CMP, Mg, Phosphate
                         BNP
                         Thyroid Function Tests
                         Iron Panel (TIBC, Ferritin, Reticulocyte count, Iron)
                         Vitamin D & calcium, PTH


               Genetics Evaluation

               Request Genetics Consult for:
                     Patients who have additional congenital malformations
                     Organ dysfunction or growth failure that cannot be explained by heart failure
                     Patients with congenital heart disease and cardiac dysfunction not explained by the
                       structural abnormality
                     Patients with congenital heart disease known to be associated with a genetic syndrome
                       and there has not previously been a genetic consult

               Request Genetics Counselor Visit for:

                     Patients with cardiomyopathy who have a known cardiomyopathy associated sarcomere
                       gene defect




               Updated 12/4/2018                                                                       page 7
   2   3   4   5   6   7   8   9   10   11   12