Heart Failure in the Pediatric Emergency: How not to miss a diagnosis?

Abstract

Introduction: In children and adolescents, the diagnosis of heart failure (HF) is a major challenge in pediatric emergencies, especially at the first presentation of the disease, in which it is confused with respiratory infections and gastrointestinal tract diseases due to the manifestation of common signs and symptoms such as tachycardia, difficulty eating, abdominal pain and nausea. Objective: To discuss clinical aspects of heart failure in pediatric patients identified in the emergency department and should be investigated as a priority in the differential diagnosis. Method: Narrative review of the literature on the clinical recognition of heart failure, emphasizing pediatric emergencies. A study was carried out in March 2024 using works from the Pubmed, Lilacs, and Scielo databases. The descriptors “heart failure AND children” and “congenital heart disease” were applied. Articles in English and Portuguese published between 2013 and 2024 were selected. Data synthesis: The diagnosis of HF in a pediatric emergency requires a multiparametric approach due to the absence of specific symptoms. Tachypnea, tachycardia, increased work of breathing, loss of appetite, abdominal pain, nausea and vomiting are the main findings in the care of pediatric patients diagnosed with HF. However, due to its non-specific characteristic, this diagnosis is often missed in the first consultation. Conclusions: This review summarizes in a practical way the main forms of presentation of HF in childhood, guiding the pediatrician to carry out a systematic approach to the patient, so that no diagnosis is missed in the pediatric emergency.