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Heart Failure in Children - not always the same as in adults

Understanding Heart Failure in Children

What is heart failure?

Heart failure occurs when the heart doesn’t pump/function properly. It happens when the heart fails to pump the requisite amount of blood, required by the organs to function normally. This causes a dip in the effective oxygen supply and organ failure can occur in the body. There are two forms main of heart failure in children – over-circulation and pump failure.

What are the Major causes of heart failure in children?

The causes of congestive heart failure in children can vary for each case. Some of the most common causes are:

● Heart failure secondary to over-circulation can occur secondary to structural heart defects that are found at birth called congenital heart disease. This can lead to oxygen poor and oxygen rich blood mixing together inside the heart. Other forms of over-circulation can be secondary to anemia or leaking valves. This can also be seen in AV malformations in which blood vessels in the head, lungs or other parts of the body causes mixing of oxygen rich and oxygen poor blood.

● Heart failure secondary to pump malfunction can occur for variety of reasons including

○ failure of heart muscle contraction and relaxation.

○ metabolic conditions that can impact the energy usage of the body.

○ inflammation of the heart or infections in it leading to myocarditis or endocarditis.

○ Sometimes the medications used for the treatment of other illnesses can have serious side effects on the heart, and cause changes to heart function.

What are the symptoms of heart failure in children?

There are many symptoms of heart failure, which can differ by age and diagnosis. These symptoms can be segregated into different groups based on the body area they occur in.


● Headache

● Irritation


● Clammy and cold skin

● More than normal sweating – especially with feeding as a newborn

● Change in skin color and/or temperature


● Increased heart rate

● Palpitations

● Difficulty breathing during physical activities


● Shortness of breath

● Cough and congestion

● Fast breathing

● Breathing difficulty during physical activities

Nutrition and Feeding

● Weight loss

● Slow weight gain

● Sudden weight gain in a short period

● Poor appetite

● Nausea or vomiting

● Fluid accumulation in the abdomen

Other Symptoms

● Feeling exhausted

● Fatigue

● Sudden fainting

● Falling asleep while eating

● Swelling of eyelids, face, legs, ankles, and abdomen (in rare cases)

How can heart failure be diagnosed in children?

If there is suspicion of your child having a heart problem, your child may get referred to a Pediatric cardiologist (like those at Pediatric Cardiology Consultants of South Texas), a doctor who specializes in the diagnosis and treatment of heart diseases in children.

The evaluation may require a series of diagnostic procedures such as:

Electrocardiography (ECG) - to record the rhythm of the heart and observe changes to the rhythm.

Echocardiography - studies the heart structures, movement of heart valves and chambers using ultrasound waves

Chest X-ray - to check for the presence of fluid in the lungs and observe the heart size.

Blood and urine tests - to look for any abnormality which can indicate heart failure.

In addition, other tests may be required such as:

Cardiac catheterization - to measure oxygen and pressure levels inside the heart by inserting a catheter tube into a blood vessel and moving it to the heart

Cardiac CTA or MRI: To evaluate the cardiac anatomy and structures for congenital heart disease and signs of heart failure.

What are the possible treatments of heart failure in children?

The treatment course advised for a child with heart failure will depend on the exact cause of the problem, the extent of the failure, and the child's metabolic and physical tolerance towards specific medications, therapies, and procedures. A child that currently has heart failure from over-circulation will need different treatment from a child that has heart failure from a metabolic disease causing pump failure.

Medicines that are commonly used to treat congenital heart failure in children include:

Diuretics - help to remove the extra fluid that may get accumulated in the body

Beta-blockers - these help in lowering the heart rate and blood pressure in the body

Digoxin - helps the heartbeat with a proper rhythm

ACE inhibitors/ARBs - help in the dilation of the blood vessels which allows for easier pumping of blood by the heart

If medications do not provide relief or recovery, other procedures and treatments may be used. These include:

Pacemaker - This is a device that controls the heartbeat by making the heartbeat at a normal rate.

Cardiac resynchronization therapy - This is for children with long-term heart failure and makes use of a special pacemaker to assist in synchronizing the heart chambers to function together.

Mechanical support or heart transplant -this is reserved for children with significant heart failure that might require extensive support and replacement of the current pump/heart as a last resort.

While heart failure can happen to any child, it is not always a hopeless condition. In simple cases of heart failure such as over-circulation medications can be used and surgical procedures can be performed if needed. In most cases, the child recovers from the condition and may or may not require further evaluation and treatment.

Treatment of the different forms of heart failure needs to be managed by physician is with expertise in pediatric cardiology and if needed specifically heart failure. We at the Pediatric Cardiology Consultants of South Texas are here to provide treatment and coordination of care for patients with heart failure of various different kinds.

Call us today at 210.655.4278 if any questions arise and you need further advice, discussion or treatment of heart failure in children and adolescents.

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