Left ventricular failure in infancy

In most of the cardiovascular abnormalities resulting in congestive cardiac failure in infancy, the major hemodynamic problem is the inability of the left ventricle to meet its work requirements. As a result this chamber dilates leading to cardiac enlargement, pulmonary congestion, and elevated right sided cardiac pressures. The clinical and laboratory features reflect the hemodynamics by showing dyspnea, left sided cardiac enlargement, and pulmonary hypertension. The clinician, recognizing the presence of left ventricular failure, must identify the underlying cardiac abnormality. The differential diagnosis of left ventricular failure may be based upon the physiologic mechanisms leading to failure. Volume overload of the left ventricle, pressure overload of the left ventricle, and alteration in myocardial contractility are the three mechanisms by which the left ventricle fails. By determining which of the three mechanisms is present in the patient, the clinician can formulate a more logical differential diagnosis.