Page 7 - Heart Failure Protocols
P. 7

Pediatric Heart Failure Guidelines

                                           Heart Failure 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

               Heart Failure - Initial Tests

                   Imaging
                       •  CXR (PA & LAT)
                       •  Echocardiogram
                       •  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





























               Updated 3/1/2018                                                                        page 7
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