Clinical manifestations of heart failure in children

The situation of heart failure in children is still quite critical. Many children with heart failure will directly experience symptoms of difficulty breathing. In this case, they must be given oxygen as soon as possible to make their condition improve faster. Some children will also have a series of symptoms on the skin, leading to wheezing in the lungs. These are relatively common symptoms.

1. Acute heart failure

(1) Early symptoms: Early signs of reduced left ventricular function include fatigue, significantly reduced exercise tolerance, and a heart rate increase of 15 to 20 beats per minute in people with normal heart function, followed by exertional dyspnea, paroxysmal nocturnal dyspnea, and high-pillow sleep. Examination may reveal left ventricular enlargement, early or mid-diastolic gallop rhythm, and moist rales, dry rales, and wheezing at the bases of both lungs.

(2) Acute pulmonary edema has an acute onset and can rapidly develop into a critical condition. Sudden severe dyspnea, orthopnea, wheezing, irritability and fear, with a respiratory rate of 30 to 50 times per minute; frequent coughing and spitting up large amounts of pink foamy sputum; rapid heart rate, with a gallop rhythm often audible at the apex of the heart; both lungs are filled with moist rales and wheezing.

(3) Cardiogenic shock 1) Hypotension persists for more than 30 minutes, with systolic blood pressure dropping below 90 mmHg, or systolic blood pressure drops by ≥60 mmHg in patients with pre-existing hypertension. 2) Tissue hypoperfusion state ① Clammy, cold, pale and cyanotic skin with purple streaks; ② Tachycardia > 110 beats/min; ③ Significant decrease in urine output (<20 ml/h), or even anuria

④ Disorder of consciousness, often with irritability, agitation, anxiety, fear and a sense of impending death; systolic blood pressure is lower than 70 mmHg, inhibitory symptoms may appear, gradually developing into confusion or even coma. 3) Hemodynamic disorder: PCWP ≥ 18 mmHg, cardiac output index (CI) ≤ 36.7 ml/s·m (≤ 2.2 L/min·m). 4) Metabolic acidosis and hypoxemia

2. Chronic heart failure

(1) Symptoms and signs of left heart failure Most patients with left heart failure seek medical attention due to decreased exercise tolerance, dyspnea or fatigue. These symptoms may occur at rest or during exercise. The same patient may have multiple diseases.

Dyspnea is the most common symptom of left heart failure and can manifest itself in various forms, including exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Decreased exercise endurance and fatigue are manifestations of insufficient blood supply to skeletal muscles. Patients with severe heart failure may experience Cheyne-Stokes respiration, which indicates a poor prognosis. In addition to the existing signs of heart disease, physical examination may also reveal enlarged left ventricle, alternating strong and weak pulses, and rales in the lungs can be heard by auscultation.