Suspected Acute Heart Failure Clinical Pathway — Emergency Department, ICU and Inpatient

Further Diagnostic Work-up
Cardiac Catheterization	Evaluate pulmonary artery pressure (especially with restrictive CM) Rule out a coronary anomaly Consider an endomyocardial biopsy (EMB) Class 1 indications for EMB New onset HF (< 2 weeks) with a normal-sized or dilated LV and hemodynamic compromise New onset HF (2 weeks – 3 months duration) associated with a dilated LV and new ventricular arrhythmias, second- or third-degree heart block, or failure to respond to usual care within 1 to 2 weeks
MRI	Consider to further delineate the etiology of heart failure (e.g. myocarditis) and better characterize the myocardium for inflammation and fibrosis.
Evaluate Source Use Cardiomyopathy or Myocarditis order set	Respiratory Virus Panel Myoplasma Parvovirus Adenovirus RSV Influenza A/B Parainfluenza A/B Metapneumovirus Rhinovirus Serum Enteroviruses (coxsackievirus) CMV, EBV, HHV-6 Parvovirus B19 Adenovirus Parechovirus HIV Mycoplasma Cultures Blood, urine and sputum Urine Adenovirus, enterovirus, parechovirus

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.