Emergency Department, ICU, and Inpatient Clinical Pathway
for the Child with Suspected Acute Heart Failure

Patient at High Risk for
Heart Failure

History of:
  • Prior heart failure
  • Cardiomyopathy
  • Heart transplantation
  • Metabolic/mitochondrial disease
  • (e.g. Duchenne Muscular Dystrophy)
Family history of:
  • Heart failure
  • Cardiomyopathy
  • Heart Transplantation

History & Physical Examination

MD/APP/RN Rapid Assessment
  • ABCDE, Mental Status
  • Monitor VS
  • Consider O2 therapy
  • Immediate IV Access
Initial Evaluation to Consider
  • CBC, Troponin-I, BNP, BMP, LFTs
  • CXR, ECG
  • VBG lactate, mixed venous O2 saturation from central line access
  • ED team consults Cardiology for concern of suspected
    acute heart failure.
  • Evaluate need for immediate diuretic, additional therapies.
  • Determine timing, location of echocardiogram.
  • Disposition to appropriate unit.
WARM & WET
  • Increased ventricular filling pressures
  • Pulmonary edema w/ adequate perfusion
COLD & WET
Increased ventricular filling pressures
  • Pulmonary edema w/ poor perfusion
  • Require ICU care
COLD & DRY
Normal ventricular filling pressures
  • Pulmonary edema w/ poor perfusion
  • Dire condition
Require ICU care
Persistent Symptoms
Escalation of Care
  • Respiratory Support
  • Mechanical Support
  • Chronic IV inotrope
    (Milrinone)
  • Transplant
Improved Function, symptom relief
Posted: February 2016
Revised: February 2018 (Reviewed), April 2020
Authors: J. Rossano, MD; K. Lin, MD; T. Conlon, MD; S. Helman, RN; M. Franco, MD; J. Lavelle, MD; M. O'Connor, MD; R. White, RN; A. Patton, RN; M. Yowell, CRNP; E. Ramsey, PharmD; C. Wittlieb-Weber, MD; D. Burstein, MD; H. Collier, PharmD;