What is heart failure?
Heart failure, also called congestive heart failure, is a condition where the heart can't pump enough blood to the body's organs. Usually, heart failure is an indication of a progressive, underlying heart condition.
Causes of heart failure in children
Heart failure can occur in children with congenital heart defects. Other medical problems that can cause heart failure include, but are not limited to:
- Enlargement of the heart
- Heart valve disease
- Cardiac arrhythmias (irregular heartbeats)
- Chronic lung disease
- Anemia (this is uncommon in children)
- Viral infection
- High blood pressure (called hypertension)
- Excessive bleeding (called a hemorrhage)
- Overactive thyroid
- Complications after surgery
- Side effects of medication, especially certain chemotherapy drugs
Symptoms of heart failure
Heart failure can affect the right side of the heart, the left side of the heart, or both sides.
When the right side of the heart begins to function poorly, it is unable to pump enough blood to the lungs, and blood begins to back up into the veins. This causes swelling in the feet, ankles, lower legs, eyelids and stomach area due to fluid retention.
When the left side of the heart fails, it is unable to pump enough blood to the rest of the body, and blood begins to back up into the blood vessels of the lungs. This makes breathing more difficult. When the body doesn’t have enough blood, a person in heart failure experiences fatigue and doesn’t grow at a normal rate.
Symptoms of heart failure vary depending on the heart’s pumping capacity, but may include:
- Visible swelling of the legs, ankles, eyelids, face and (sometimes) the stomach area
- Fast breathing, labored breathing or shortness of breath
- A fluttering feeling in the chest
- Fatigue
- Nausea
- Falling asleep when feeding or feeling too tired to eat
- Lack of appetite
- Weight gain over a short period of time, even with poor appetite, which is due to fluid retention
- Cough and congestion in the lungs
- Sweating while feeding or playing
- Difficulty breathing with activity, especially while feeding, walking, or climbing stairs
- Loss of muscle mass
- Failure to gain weight
- Change in skin temperature and color, such as cold and clammy, or sweaty, flushed and warm
The symptoms of heart failure may be similar to other conditions or medical problems. Always consult your child's healthcare provider for a diagnosis.
Diagnosing heart failure
Your child's doctor will review your child’s medical history and do a physical exam. They will ask questions about your child's appetite, breathing patterns, and energy level. Other tests for heart failure may include:
- Blood and urine tests
- Chest x-ray
- Echocardiogram (also called echo or ultrasound), which is when sound waves create an image of the heart
- Electrocardiogram (ECG or EKG), which is a record of the electrical activity of the heart
- Cardiac magnetic resonance imaging (MRI), which is a 3-D image that shows the heart’s structures in detail
- Cardiac catheterization, which is when a thin tube is inserted into the heart through a vein and/or artery in the leg to provide detailed information about the structure and function of the heart
Treatment for heart failure
Your doctor will determine the best treatment for your child’s heart failure depending on several factors:
- Your child's age, overall health and medical history
- Extent of the disease
- Your child's tolerance for specific medications, procedures or therapies
- Expectations for the course of the disease
If your child’s heart failure is caused by a heart defect that was present at birth (a congenital heart defect) or an acquired heart problem, such as rheumatic valve disease, surgical repair of the problem may be necessary. Medications or pacemakers are often helpful in treating heart failure at first. Eventually, medications may lose their effectiveness and many congenital heart defects will need to be repaired surgically. Medications may also be used after surgery to help improve heart function while your child heals.
Medications that are often used to treat heart failure in children may include:
- Digoxin, which can help the heart beat stronger with a more regular rhythm
- Diuretics, which help the kidneys remove excess fluid from the body
- Potassium-sparing diuretics, which help the body retain potassium, an important mineral and electrolyte that is often lost when taking diuretics
- ACE (angiotensin-converting enzyme) inhibitors, which help to dilate the blood vessels, making it easier for the heart to pump blood forward into the body
- Beta blockers, which decrease the heart rate and blood pressure, allowing the heart to pump more efficiently
People who are dependent on a pacemaker can go on to develop pacemaker-induced cardiomyopathy. Cardiac resynchronization therapy, or device therapy, is a newer treatment for heart failure that is due to long-term pacemaker dependence. Device therapy uses a special type of pacemaker that paces both sides of the heart simultaneously to coordinate contractions and improve the heart’s pumping ability.
Ventricular assist devices
Ventricular assist devices (VAD) are used to pump blood for the heart when it isn’t working properly. The device pumps blood from the heart’s pumping chamber (ventricle) to the body through the aorta, the largest blood vessel in the body. Sometimes these devices can stay in for months or even years and can be used as a bridge to recovery of the heart’s function or as a bridge to heart transplantation.
Some children who develop heart failure will need a heart transplantation. Your care provider will give you specific information about the best course of treatment for your child.
Why Choose Us
Our specialists are leading the way in the diagnosis, treatment, and research of congenital and acquired heart conditions.
Resources to help
Cardiac Center Resources
We know that caring for a child with a heart condition can be stressful. To help you find answers to your questions – either before or after visiting the Cardiac Center – we’ve created this list of educational health resources.
Meet your team
Your child will be cared for by one of the most accomplished teams of pediatric cardiology experts in the world. We make sure you and your child get the highest level of support.
Reviewed by Lynne N. Ha, BSN, MSN
Reviewed on 08/01/2024