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Differential Diagnosis - Yimg


									Differential Diagnosis
       Differential Diagnosis
• Many classes of disorders can result in
  increased cardiac demand or impaired
  cardiac function.

• Cardiac causes include:
  - arrhythmias (tachycardia or bradycardia)
  - structural heart disease
  - myocardial dysfunction (systolic or
       Differential Diagnosis
• Noncardiac causes of congestive heart
  failure (CHF) include processes that:

 - increase the preload (volume overload)
 - increase the afterload (hypertension)
 - reduce the oxygen-carrying capacity of
   the blood (anemia)
 - or increase demand (sepsis)
       Differential Diagnosis
• The most likely causes of congestive heart
  failure depend on the age of the child.

• Congestive heart failure in the fetus, or
  hydrops, can be detected by performing
  fetal echocardiography.
          Differential Diagnosis
• Neonates and infants younger than 2 months are the
  most likely group to present with congestive heart failure
  related to structural heart disease.

• The systemic or pulmonary circulation may depend on
  the patency of the ductus arteriosus, especially in
  patients presenting in the first few days of life. In these
  patients, prompt cardiac evaluation is mandatory.

• Myocardial disease due to primary myopathic
  abnormalities or inborn errors of metabolism must be

• Respiratory illnesses, anemia, and known or suspected
  infection must be considered and appropriately
           Diffrential Diagnosis
• In older children, congestive heart failure may be caused

   - left-sided obstructive disease (aortic stenosis or
   - myocardial dysfunction (myocarditis or
   - hypertension
   - renal failure
   - arrhythmias or myocardial ischemia.
       Differential Diagnosis
Illicit drugs such as inhaled cocaine and other stimulants
are increasingly precipitating causes of congestive heart
failure in adolescents; therefore, an increased suspicion
of drug use is warranted in unexplained congestive heart

Although congestive heart failure in adolescents can be
related to structural heart disease (including
complications after surgical palliation or repair), it is
usually associated with chronic arrhythmia or acquired
heart disease, such as cardiomyopathy.
             Differential Diagnosis
• Characteristic findings in children with heart failure include the

• Cardiac rhythm disorders may be caused by the following:
    –   Complete heart block
    –   Supraventricular tachycardia
    –   Ventricular tachycardia
    –   Sinus node dysfunction

• Volume overload may be caused by the following:
    – Structural heart disease (eg, ventricular septal defect, patent
      ductus arteriosus, aortic or mitral valve regurgitation, complex
      cardiac lesions)
    – Anemia
    – Sepsis
           Differential Diagnosis
• Pressure overload may be caused by the following:
• Structural heart disease (eg, aortic or pulmonary stenosis,
  aortic coarctation)
• Hypertension

• Systolic ventricular dysfunction or failure may be caused by
  the following:
• Myocarditis
• Dilated cardiomyopathy
• Malnutrition
• Ischemia

• Diastolic ventricular dysfunction or failure may be caused by
  the following:
• Hypertrophic cardiomyopathy
• Restrictive cardiomyopathy
• Pericardial or cardiac tamponade

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