II. Causes: General

III. Causes: Age of presentation

  1. Week 1: Hypoplastic Left Heart Syndrome
  2. Week 2: Aortic Coarctation
  3. Week 4-12: Ventricular Septal Defect
  4. After Week 12: Valvular heart disease, Myocarditis

IV. Symptoms

  1. Poor feeding
  2. Diaphoresis with feeding

V. Signs

  1. See Congenital Heart Disease
  2. See Pediatric Murmur
  3. Biventricular failure is the rule
  4. S3 Heart Sound
  5. Tachypnea and other signs respiratory disease
  6. Tachycardia
  7. Hepatomegaly
  8. Pallor

VI. Differential Diagnosis

  1. Neonatal Sepsis
  2. Congenital metabolic conditions

VII. Management

  1. Initiate transport to pediatric ICU facility
  2. Immediate pediatric Consultation
  3. Oxygen
    1. High Flow Oxygen indicated in most patients
    2. Do not increase FiO2 in hypertrophic left heart
      1. Keep the ductus arteriosus patent
  4. Endotracheal Intubation with ventilations
  5. Digoxin 20 ug/kg IV for 1 dose
  6. Furosemide 1-2 mg/kg IV
  7. Fluids to 66% of expected fluid maintenance requirement
  8. Sedation with Morphine Sulfate 0.05 to 0.1 mg/kg IV

VIII. References

  1. Herndon (2003) AAFP Board Review, Seattle

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