Pediatric Cardiology

, Volume 13, Issue 2, pp 72–75 | Cite as

Grading the severity of congestive heart failure in infants

  • Robert D. Ross
  • Robert O. Bollinger
  • William W. Pinsky
Original Articles

Summary

To determine which variables most accurately define congestive heart failure (CHF) in infants, 41 patients (median age 2.5 months) were graded by four pediatric cardiologists for the presence and severity of CHF based on the following variables: amount of formula consumed per feeding, feeding time, history of diaphoresis or tachypnea, growth parameters, respiratory and heart rates, respiratory pattern, perfusion, presence of edema, diastolic filling sounds, and hepatomegaly. There were 19 patients graded as having no CHF, nine as mild, seven moderate, and six severe CHF. The most sensitive and specific variables (p<0.0001) for the presence of CHF were a history of <3.5 oz/feed, respiratory rate >50/min, an abnormal respiratory pattern, diastolic filling sounds, and hepatomegaly. Moderate to severe CHF was present when patients took <3 oz/feed or >40 min/feed, had and abnormal respiratory pattern with a resting respiratory rate >60/min, and had a diastolic filling sound and moderate hepatomegaly. Severe CHF was accompanied by a heart rate >170/min, decreased perfusion, and severe hepatomegaly. Thus, the grading of the severity of CHF in infants should include an accurate description of these historical and clinical variables.

Key Words

Congestive heart failure Congenital heart disease 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Di Donato RM, Fyfe DA, Puga FJ, Danielson GK, Ritter DG, Edwards WD, McGoon DC (1985) Fifteen-year experience with surgical repair of truncus arteriosus.J Thorac Cardiovasc Surg 89:414–422Google Scholar
  2. 2.
    Dillon TR, Janos GG, Meyer RA, Benzing G, Kaplan S (1980) Vasodilator therapy for congestive heart failure.J Pediatr 4:623–629Google Scholar
  3. 3.
    Doty DB, Scheken RM, Lauer RM (1979) Septation of the univentricular heart.J Thorac Cardiovasc Surg 78:423–430Google Scholar
  4. 4.
    Dunnigan A, Staley NA, Smith SA, Pierpont ME, Judd D, Benditt DG, Benson DW (1987) Cardiac and skeletal muscle abnormalities in cardiomyopathy: Comparison of patients with ventricular tachycardia or congestive heart failure.J Am Coll Cardiol 10:608–618Google Scholar
  5. 5.
    Girod DA, Fontan F, Deville C, Ottenkamp J, Choussat A (1987) Long-term results after the Fontan operation for tricuspid atresia.Circulation 3:605–610Google Scholar
  6. 6.
    Guyatt GH, Sullivan MJJ, Fallen EL, Tihal H, Rideout E, Halcrow S, Nogradi S, Townsend M, Taylor DW (1988) A controlled trial of digoxin in congestive heart failure.Am J Cardiol 61:371–375Google Scholar
  7. 7.
    Ilbawi MN, Idriss FS, DeLeon SY, Muster AJ, Duffy CE, Gidding SS, Paul MH (1987) Valve replacement in children: Guidelines for selection of prosthesis and timing of surgical intervention.Ann Thorac Surg 44:398–403Google Scholar
  8. 8.
    Kirklin JK, Blackstone EH, Kirklin JW, Pacifico AD, Bargeron LM, (1986) The Fontan operation.J Thorac Cardiovasc Surg 92:1049–1064Google Scholar
  9. 9.
    Kirklin JW, Pacifico AD, Blackstone EH, Kirklin JK, Bargeron LM (1986) Current risks and protocols for operations for double-outlet right ventricle.J Thorac Cardiovasc Surg 92:913–930Google Scholar
  10. 10.
    Kubo SP, Clark M, Laragh JH, Borer JS, Cody RJ (1987) Identification of normal neurohormonal activity in mild congestive heart failure and stimulating effect of upright posture and diuretics.Am J Cardiol 60:1322–1328Google Scholar
  11. 11.
    Russo P, de Leval MR, Triumbari F, Dodd S, Wyse RKH (1987) Ebstein's anomaly diagnosed in the first year of life: Survival curve, clinical and pathological considerations [Abstract].Circulation 76 (Suppl):IV-553Google Scholar
  12. 12.
    The Criteria Committee of the New York Heart Association (1964)Diseases of the heart and blood vessels; nomenclature and criteria for diagnosis, 6th edn. Little, Brown and Co., Boston, p 112Google Scholar
  13. 13.
    Vaughan VC, Litt IF (1987) Developmental pediatrics. In: Behrman RE, Vaughan VC (eds)Nelson textbook of pediatrics, 13th edn. WB Saunders, Philadelphia, pp 25–26Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1992

Authors and Affiliations

  • Robert D. Ross
    • 1
  • Robert O. Bollinger
    • 1
  • William W. Pinsky
    • 1
  1. 1.Division of Cardiology, Department of Pediatrics, Children's Hospital of MichiganWayne State University School of MedicineDetroitUSA

Personalised recommendations