Heart Failure in Children
The term “heart failure” does not mean that the heart has stopped working – rather, that the heart doesn’t work as well as it should. Though many people think of heart failure as a condition that only affects adults, people of all ages can develop the condition, including babies, children, teens and young adults.
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Heart failure, also called congestive heart failure, is a condition in which the heart cannot pump or fill with blood sufficiently to meet the energy needs of the body’s organs. Multiple medical problems can cause heart failure, the result of which is that blood backs up (congests) in the blood vessels, leading to fluid buildup in the lungs or other parts of the body.
What Causes Heart Failure in Children?
The most common cause of heart failure in children is a heart defect that is present at birth (congenital). Other medical issues that can lead to heart failure include:
- Cardiomyopathy (disease of the heart muscle)
- Heart valve disease
- Cardiac arrhythmias (irregular heartbeats)
- Lung disease
- Anemia
- Hypertension (high blood pressure)
- Thyroid disease
- Viral infections
- Side effects of medication, especially from certain chemotherapy drugs
How Does Heart Failure Affect the Body?
Heart failure can impair the pumping ability of either the right side of the heart, the left side of the heart or both sides. Sometimes heart failure occurs when the heart is unable to fill with blood well. When the right side of the heart is affected, the heart is unable to pump enough blood to the lungs. This causes back up of blood to the rest of the body, resulting in swelling in the lower legs, ankles, feet, abdomen and eyelids.
When heart failure affects the heart’s left side, the ability to pump blood out to the body is diminished. In this situation, blood backs up into the lungs, causing trouble breathing and other symptoms.
Symptoms of Heart Failure in Children
The type and severity of symptoms of heart failure in children depends on which side of the heart is affected and how much of the heart’s pumping capacity has been affected. Symptoms may include:
- Swelling (edema) of the ankles, feet, lower legs, abdomen, liver, eyelids, face and neck
- Breathing problems, including shortness of breath, labored breathing, rapid breathing, wheezing and excessive coughing, especially during activity
- Poor feeding and poor weight gain in infants
- Failure to gain weight in older children
- Fatigue
- Nausea or vomiting
- Lack of appetite
- Excessive sweating while feeding, playing or exercising
- Irritability
- Loss of muscle mass
- Changes in skin temperature and color (cold and clammy skin or skin that is sweaty, flushed and warm)
- Chest pain
- Fainting
The signs and symptoms of heart failure in children often resemble those of other conditions or medical issues. Be sure to consult your child’s healthcare provider for a proper diagnosis.
Diagnosis of Heart Failure in Children
Your child’s healthcare provider will obtain a complete medical history of your child and perform a physical examination, asking you questions about your child’s appetite, breathing patterns and energy level. If your child’s physician suspects heart failure, he or she may refer them to a pediatric heart specialist for further evaluation and testing.
The diagnostic tests used to check for heart failure in your child may include:
- Chest X-ray
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An imaging test that uses X-rays to look at structures and organs in the chest, including the heart and lungs
- Electrocardiogram (ECG or EKG)
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A noninvasive test that records the electrical activity of the heart, identifies abnormal rhythms (arrhythmias or dysrhythmias), and may help detect heart muscle abnormalities
- Echocardiogram (echo)
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In this noninvasive test, sound waves are used to evaluate the motion of the heart's valves and chambers. As a sonographer passes an ultrasound transducer over the chest, sound waves bounce off the heart to produce an image on a monitor. An echo can detect changes caused by heart failure, including enlarged heart chambers.
- Cardiac MRI
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This noninvasive test uses a large magnet to take detailed pictures of the heart. Like an echo, it looks at that motion of the heart, but also can look at the structure of the muscle of the heart and assess for any scarring in the heart.
- Cardiac catheterization (cath)
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In this invasive test, the physician introduces a small, flexible tube (catheter) into the heart from the arm or groin to obtain pressure measurements inside the heart that aid in the diagnosis of heart failure. Also, biopsies of heart tissue may be obtained during the procedure to help identify the underlying cause of the heart failure.
- Blood and urine tests
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Abnormal results of certain blood and urine tests may help in the diagnosis of heart failure.
The Long-Term Outlook for Children With Heart Failure: A Cause for Optimism
Long-term outlook depends on the cause of the heart failure and the response of the patient. Some children with heart failure completely regain normal heart function following treatment; however, heart failure is often a long-term medical condition. Even so, the number of effective ways in which doctors treat and manage chronic heart failure in both children and adults continuously increases as clinicians discover and develop new treatment options. As a result, children with heart failure often grow and lead healthy, happy and active lives.
Treatment for heart failure in children
Specific treatment measures for pediatric heart failure depend on:
- Your child’s age, medical history and overall health
- The severity and progression of the disease
- Your child’s tolerance for certain medications, procedures or therapies
- Prognosis of the disease
- Parent opinions and preferences
Surgery may be necessary when the cause of the heart failure is a congenital heart defect or certain acquired heart conditions, such as rheumatic valve disease. Often, medications are helpful in initial heart failure treatment. However, the effectiveness of medications can decrease over time so that many congenital heart defects eventually require surgical repair. Medications may also be useful in improving heart function during the healing period following surgery.
Medications commonly prescribed to treat heart failure in children include:
- Digoxin: Helps the heart beat stronger and with a more regular rhythm
- ACE (angiotensin-converting enzyme) inhibitors: Helps dilate the blood vessels to make pumping blood forward into the body easier for the heart
- Beta blockers: Help decrease blood pressure and heart rate, resulting in improved heart pumping efficiency
- Diuretics: Assist the kidneys in removing excess fluid from the body
- Potassium-sparing diuretics: Improve the body’s ability to retain potassium, an important mineral and electrolyte that is often lost during diuretic therapy
Other treatments for heart failure include:
- Pacemaker: Some children with heart failure require an artificial pacemaker, a device that improves heart pumping function by preventing the heart from beating too slowly.
- Cardiac resynchronization therapy: This therapy uses a special type of pacemaker that paces both sides of the heart simultaneously to coordinate contractions and improve pumping ability. This treatment is indicated for use in some children with long-term heart failure.
- Mechanical support devices: Certain special devices and tools may be used to help children with severe heart failure, including patients waiting for a heart transplant.
- Heart transplant: If heart muscle function continues to deteriorate after exhausting other treatment options, your child’s cardiologist may discuss the need for a heart transplant.