Page 7 - Heart Failure Guidelines

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 4/22/2019 page 7