Definition

Heart failure is when the heart cannot work as well as it should. Problems caused by the failure will depend on the area of the heart that is affected. For example:

  • Right side heart failure—will slow blood flow to the lungs. Blood may also build up in the right side of the heart. This will lead to a back up of blood into the veins.
  • Left side heart failure—slows flow of blood out of the heart and to the body. Blood may also build up in the left side of the heart. It will then lead to a back up of blood into the lungs.

If fluid has backed up in the body or lungs it is called congestive heart failure. It is also possible to have failure on both sides of the heart. The poor flow of blood will eventually also damage other organs like kidneys.

Blood Flow through the Heart
heart

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Causes

Heart failure in kids is often caused by a problem with how blood moves through the heart. The heart muscle is has to work harder than normal to make blood flow. This may be caused by birth defects such as:

  • Holes in the wall of the heart such as ventricular or atrial septal defects
  • Leaky heart valves
  • Abnormal connections between blood vessels

A less common cause in kids is a problem with the heart itself. Disease or damage to the heart muscle can make it hard for the heart to pump well. This type of heart failure may be caused by:

  • Cardiomyopathy—enlargement of the heart muscle. There is less room for blood to move through. It also makes the heart weaker.
  • Damage to the heart tissue from one of the following:
    • Infection of the heart
    • Medical conditions such as Kawasaki
    • Medicine, such as chemotherapy

In some children, the cause may be unknown.

Risk Factors

Factors that may increase a child’s chances of heart failure include:

  • Porblems with the structure of the heart or blood vessels
  • Recent bacterial or viral infection
  • Weak or damaged heart muscle
  • Treatment with certain medicine
  • Injury to the heart (rare)

Symptoms

Symptoms can vary and can be mild to severe.

If blood is backing up in the right side of the heart, it can cause swelling. The feet, ankles, lower legs, belly, or eyelids can all be affected.

If blood is backing up in the left side of the heart, it can make it hard to breathe.

General symptoms of heart failure may include:

  • Rapid breathing
  • Shortness of breath
  • Get very tired easily
  • Need rest breaks often during activity
  • Slowed or stopped growth
  • Nausea or vomiting
  • Excessive sweating

Infants may also have problems with feeding, development, and growth.

Diagnosis

You will be asked about your child’s symptoms and past health. A physical exam will be done. Your child’s doctor will check blood pressure and heart rate.

The doctor may suspect a heart problem based on exam. Tests that help to make a diagnosis include:

  • Chest x-ray—can show if fluids are backing up into lungs
  • Echocardiogram—can show movement of blood through heart

Other tests that may help to find the cause or severity include:

  • EKG—shows electrical activity of heart
  • Exercise stress test—shows how heart responds to physical demands
  • Cardiac catheterization—catheter passed to heart to get images of blood vessels

Treatment

Treatment depends on the cause and severity. The goal is to help the heart work as well as possible and avoid future problems.

The cause will need to be treated. It may stop or slow heart failure.

Treatment may also be needed to support the child. Symptoms can be managed with:

Medicine

Medicines may help decrease the workload on the heart. Options may include:

  • ACE inhibitors—to widen blood vessels and decrease blood pressure
  • Digoxin—to help the heart pump better
  • Beta-blockers—to lower blood pressure and manage heart beat
  • Diuretics—to decrease swelling by removing excess fluid

Oxygen

Oxygen (O2) therapy will increase the amount of oxygen in the blood. This will increase the amount of O2 in the body without increase work for the heart. Oxygen therapy may include:

  • Oxygen supplement—a mask or tube that fits under the nose
  • Extracorporeal membrane oxygenation (ECMO)—blood is passed outside of the body into a machine. The machine works like the lungs and pushes O2 into the blood. It is a temporary step that can give the heart and lungs a chance to rest. It may help while the body recover from an illness like infection.

Surgery

Devices may help to support the heart. They will need to be placed in the body. Options include:

  • Pacemaker—to help control the rhythm of the heart.
  • Left-ventricular assistive device (LVAD)—to help the left side of the heart pump blood to the rest of the body. For severe failure until a heart transplant is available.

If other treatment don't work, a heart transplant may be considered. The diseased heart is replaced with a healthy heart from a donor.

Prevention

Some causes of heart failure cannot be prevented. However, there are steps you can take to prevent some causes:

  • If you are or plan to become pregnant, get proper prenatal care and testing.
  • Seek prompt treatment when your child is sick.
  • Know what side effects can occur from the medicine your child takes.
RESOURCES:

American Heart Association
http://www.heart.org

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

CANADIAN RESOURCES:

Caring for Kids—Canadian Paediatric Society
http://www.caringforkids.cps.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Heart failure in children and adolescents. American Heart Association website. Available at: http://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/heart-failure-in-children-and-adolescents Updated May 31, 2017. Accessed January 9, 2019.

Hsu DT, Pearson GD. Heart failure in children. Part I: History, etiology, and pathophysiology. Circulation: Heart failure. 2009;2:63-70. Available at: http://circheartfailure.ahajournals.org/content/2/1/63.

Mechanical circulatory support for heart failure. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T483099/Mechanical-circulatory-support-for-heart-failure. Updated August 9, 2018. Accessed January 9, 2019.

Last reviewed September 2018 by EBSCO Medical Review Board Michael Woods MD, FAAP  Last Updated: 1/8/2019