The most common cause of congestive heart failure (CHF) in children is congenital heart disease, which often masquerades as other problems, such as pneumonia or sepsis. The distinction between pneumonia and congestive heart failure in infants requires a high index of suspicion. Pneumonia can cause a previously stable cardiac condition to decompensate, so that both problems exist simultaneously. The predominant symptoms include poor feeding, excessive diaphoresis, irritability or lethargy with feeding, weak cry and, in severe cases, grunting and nasal flaring. Pulmonary congestion with rales, ronchi, and wheezing may mimic common lower respiratory viral infections. Gallop rhythms may be difficult to ascertain due to the presence of tachycardia. The common symptoms and signs of an infant with congestive heart failure are outlined in T§ble...115z2,.

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