Page 6 - Heart Failure Protocols
P. 6

Pediatric Heart Failure Guidelines

               Heart Failure - General Considerations

               Heart Failure - 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

               Heart Failure 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.

                                        Heart Failure 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 3/1/2018                                                                        page 6
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