Differentiating Cardiac and Respiratory Conditions in Children

Clinical Features

• The American Heart Association suggests that children with large ASD and symptoms of cardiac failure, such as progressive feeding intolerance and failure to thrive, should be evaluated for congestive cardiac failure (CCF) 1
• The European Society of Cardiology recommends that exertional dyspnea and recurrent "chest infections" be considered as potential signs of CCF in children with large ASD 2
• Fixed splitting of the second heart sound is a pathognomonic sign for ASD, according to the American College of Cardiology 3
• A diastolic tricuspid flow rumble indicates significant shunt with Qp/Qs >2.0, as stated by the American Heart Association 3
• Hepatomegaly from right heart failure is a sign of CCF in children with large ASD, as noted by the American Academy of Pediatrics 1

Diagnostic Evaluation

• The American College of Cardiology recommends that ECG analysis be used to differentiate CCF from LRTI, with CCF showing right axis deviation, incomplete right bundle branch block, right atrial enlargement, and right ventricular hypertrophy 2, 3
• Chest X-ray interpretation can help differentiate CCF from LRTI, with CCF showing increased pulmonary vascularity bilaterally, cardiomegaly, and an enlarged pulmonary artery segment, as stated by the American Thoracic Society 3
• Echocardiographic assessment is the key differentiating test, with right ventricular volume overload and dilation confirming hemodynamically significant ASD, according to the European Society of Cardiology 2, 3

Management

• The American Heart Association recommends that children with confirmed CCF be treated with diuretics, ACE inhibitors, and digoxin for symptom management 1
• Surgical or device closure is indicated for Qp/Qs >1.5 with RV volume overload, as stated by the American College of Cardiology 8
• The American Academy of Pediatrics recommends that children with confirmed LRTI be treated with appropriate antibiotics based on age and severity, and reassessed for underlying cardiac contribution if there is a poor response to treatment 5