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Suspected Acute Heart Failure Clinical Pathway – Emergency Department, ICU and Inpatient

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

High Risk for Acute Heart Failure
  • History of:
    • Prior heart failure
    • Cardiomyopathy
    • Heart transplantation
    • Metabolic/mitochondrial disease
    • Neuromuscular disease
      e.g., Duchenne muscular dystrophy
  • Family history of:
    • Heart failure
    • Cardiomyopathy
    • Heart transplantation
 
 
 
 

ED Team Assessment

 
 

Initial Labs and Imaging

  • CBC, troponin-I, BNP, BMP, LFTs
  • CXR, ECG
  • VBG lactate, mixed venous O2 saturation from central line access
  • Cardiac POCUS as adjunct to physical assessment
 
 
Epic Consult Card Txp/Heart Failure
 
 
 
 
 
 
Warm and Wet
Cold and Wet
Cold and Dry
  • Increased ventricular filling pressures
  • Pulmonary edema with adequate perfusion
  • Increased ventricular filling pressures
    • Pulmonary edema with poor perfusion
  • Normal ventricular filling pressures
    • Poor perfusion with volume depletion
 
 
 
 
 
 
Persistent symptoms
 
 
 
 
Improved function, symptom relief
  • Respiratory support
  • Mechanical support
  • Anticoagulation
  • Chronic IV inotrope (milrinone)
  • Transplant
Discharge planning

 

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