Last Updated : 1/10/2012
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N C Joshi
Clinical manifestations
The clinical manifestations are reflections of hemodynamic derangements. The patients will have a decreased cardiac output resulting in elevated right atrial pressure with systemic venous congestion and fluid accumulation and/or elevated left atrial pressure with pulmonary venous congestion. The compensatory sympathetic stimulation results in peripheral vasoconstriction and the peripheral blood flow is redistributed in favor of the vital organs. Since these hemodynamic changes may occur separately and not at the same time, the clinical manifestations of heart failure may vary a great deal between patient to patient. Impaired myocardial function results in cardiomegaly, tachycardia, gallop rhythm, poor peripheral perfusion and growth retardation. Cardiomegaly occurs in all patients with CHF except in pulmonary venous obstruction and constrictive pericarditis. A sleeping heart rate above 160/min in infants and above 100/min in children is always present in CHF. A protodiastolic gallop at the time of rapid ventricular filling is a sign of impaired ventricular function. Poor peripheral perfusion manifests itself by cold extremities, weak pulses and low blood pressure associated with skin mottling. Growth retardation is noted in all infants with chronic CHF. Dyspnea and tachypnea are typical signs of increased pulmonary venous pressure. Respiratory rates may be as high as 80-100/min and are associated with retraction, grunting and poor feeding. Wheezing may be earliest and occasionally only evidence of pulmonary edema. Rales are relatively uncommon sign of pulmonary edema in the pediatric age group. Cyanosis , in the absence of intracardiac R -> L shunt, may be present and is secondary to impaired pulmonary gas exchange as well as due to sluggish peripheral circulation.

Signs of systemic venous congestion include hepatomegaly- if it is 2 cm or more below right costal margin in the mid clavicular line and tender, then it suggests failure due to overloading of right ventricle. There is peripheral edema involving pretibial, sacral and periorbital areas.

Table 1: Clinical manifestations of CHF

Failure to thrive
Tachypnea, dyspnea
Gallop rhythm
Peripheral edema
Peripheral cyanosis
Poor pulses

Contributor Information and Disclosures N C Joshi
Consultant Pediatrician and Pediatric Cardiologist, Nanavati Hospital, Mumbai, India

First Created : 1/12/2001
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