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
  • 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
  • Diastolic function
  • Inotropes
  • Respiratory Support
  • Mechanical Support
  • Chronic IV
  • Transplant
Improved Function, symptom relief
Posted: February 2016
Reviewed: February 2018
Authors: J. Rossano MD, R. Shaddy MD, K. Miller CRNP, R. Mansfield MD, K. Lin MD, T. Conlon MD, D. Nandi MD, C. Lebo CRNP, C. Bober CRNP, S. Helman RN, M. Franco MD, J. Lavelle MD, M. O'Connor MD, R. Ryan RN, A. Patton RN, M. Yowell CRNP, E. Ramsey, PharmD