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

History and Physical Examination

Symptoms of acute heart failure overlap with common symptoms of viral illness, which make it difficult to detect. Remember that both non-specific GI and respiratory symptoms are quite common, particularly in infants and adolescents. Description/duration of symptoms are also important.

History		Physical Exam
Symptoms	All Children Abdominal pain, nausea, vomiting Respiratory abnormalities/tachypnea Neonates/Infants Irritability Feeding: Tires easily Extended time to complete feeds Tachypnea/diaphoresis with feeds Emesis with feeds Growth failure Children/Adolescents Exercise intolerance Easy fatigability Poor appetite Orthopnea Cough Edema Chest pain, palpitations, syncope Weight gain or loss Decreased urine output	Vital Signs	Tachycardia Tachypnea Hypo/hypertension Hypoxia
		Cardiac	Gallop rhythm New murmur Jugular vein distension Delayed capillary refill, weak pulses
		Pulmonary	Increased work of breathing Wheeze Rales
Past Medical History	Cardiac History Presence of chronic heart failure Existing congenital heart disease (CHD) Medical/surgical interventions for CHD Cardiomyopathy (CM) Cardiac transplant Neonates/Infants History of birth asphyxia Incessant tachyarrhythmia Severe anemia Other Known genetic/metabolic syndrome Rheumatic heart disease Hypothyroidism Kawasaki disease Cancer/chemotherapy Drug exposure (prescribed, recreational)	Abdominal	Hepatomegaly Abdominal distension Abdominal tenderness
		Neurologic	Altered mental status
		Skin	Mottling Pallor Extremities may be cool or warm
Family History	Family history of CM, sudden cardiac death	Other	Thyroid enlargement Peripheral edema (rare in infants)

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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

History and Physical Examination

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Suspected Acute Heart Failure — History and Physical Examination — Clinical Pathway: Emergency, ICU and Inpatient

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

History and Physical Examination