Page 6 - Heart Failure Guidelines

Pediatric Heart Failure Guidelines

Heart Failure - General Considerations

Initial Evaluation

Detailed History and Physical with special attention to the following:
• Cardiac Review of Systems
• Growth Chart Review
• Nutritional Assessment
• Medical History
• Surgical History
• Family History of Heart Disease, Cardiomyopathy, Sudden Death, Transplantation
• Fetal and Perinatal History
• Hospitalizations
• Medications
• Newborn Screening

Documentation
It is important to document the heart failure stage and symptoms.
A task force representing the American College of Cardiology and the American Heart
Association developed a staging system (stages A to D) to describe the development and
progression of the heart failure in adults modified for infants and children by the International
Society of Heart and Lung Transplantation (ISHLT). ACC/AHA Disease staging should be
documented on initial and subsequent visits.

Disease Staging for Infants & Children
Class Description Examples
A At an increased risk of developing heart Exposure to cardiotoxic agents, family history of heritable
failure but with normal cardiac function cardiomyopathy, and single ventricle anatomy
and chamber size
B Abnormal cardiac morphology or Aortic regurgitation with left ventricular dilation, history of
function with no past or current anthracycline exposure with left ventricular dysfunction
symptoms of heart failure
C Past or current heart failure symptoms Cardiomyopathy or congenital heart disease patients with
and structural or functional heart symptomatic systolic ventricular dysfunction
disease
D Marked symptoms at rest despite Requiring specialized interventions e.g. continuous infusion
maximal medical management of inotropic agents, mechanical circulatory support, heart
transplantation or hospice care

Heart failure has been classified to describe the severity of symptoms. The two most common
heart failure symptom classifications used in pediatrics are the New York Heart Association
(NYHA) and the Ross classification. The NYHA classification is most commonly used to quantify
the degree of functional limitation imposed by heart failure in adults and may be useful in
adolescents. The Ross classification is more applicable in infants and young children and has
been validated in studies that used physiologic measures (including plasma levels of
norepinephrine and peripheral lymphocytic beta-adrenergic receptor density) of heart failure.
Symptom severity classification should be documented on initial and subsequent visits.

Updated 4/22/2019 page 6