Last Updated : 1/10/2012
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N C Joshi
Laboratory studies
It is to be remembered that


is a clinical syndrome and is not associated with a diagnostic laboratory test.
- X ray chest PA view shows cardiomegaly and increased pulmonary vascular markings. Normal sized heart is incompatible with

diagnosis of CHF

except in anomalous pulmonary venous return with constriction and constrictive pericarditis.
- Electrocardiograph is not diagnostic of CHF except in CHF secondary to tachyarrhythmias.
- Echocardiogram with decreased ejection fraction and low circumferential fibre shortening are direct evidence of heart failure. In addition, it differentiates systolic or diastolic dysfunction as a

cause of CHF

. Also it is helpful in the diagnosis of pericardial effusion.
- A mild degree of anemia and moderate leukocytosis are observed in CHF.
- Renal function test reveal evidence of decreased glomerular filtration rate and decreased urine output. BUN and creatinine may be elevated. Urine analysis shows proteinuria and microscopic hematuria.

Differential Diagnosis
While the diagnosis of CHF is readily accomplished in older children, it can be difficult in infants because typical cardiac findings may be absent or obscured by pulmonary disease. Also characteristic heart murmurs may not be audible in
severe CHF
, because of reduced cardiac output.

Table 2 - Differential Diagnosis of CHF

Respiratory Distress Syndrome
Acute bronchiolitis
CNS disorder
Renal disease

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

First Created : 1/12/2001
Last Updated : 1/10/2012
Contributor Information and Disclosures

Last Updated : 1/10/2012
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