• Heart Failure—Child

    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 and back up into the veins of the body.
    • 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 and back up 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
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    Causes

    Heart failure in children is most often caused by one of two factors. The most common problem is how the blood flows within the heart. Even though the heart muscle is healthy it has to work harder to create healthy blood flow. This may be caused by defects present at birth such as:
    • Holes in the wall of the heart such as ventricular or atrial septal defects—allow blood to flow from one side of the heart to the other
    • Leaky heart valves—allow blood to flow backwards in the heart
    • Abnormal connections between blood vessels—limits the amount of blood flowing in the right direction
    A second cause is a problem with the heart itself. Disease or damage to the heart muscle can make it hard for to move blood throughout the body. This type of heart failure may be caused by:
    • Cardiomyopathy—Enlargement of the heart muscle that can decrease the amount of 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
      • Medication, such as chemotherapy
    In some children, the cause may be unknown.

    Risk Factors

    Factors that may increase your child’s chances of heart failure include:
    • Structural defects in the heart or blood vessels
    • Recent bacterial or viral infection
    • Weak or damaged heart muscle—cardiomyopathy
    • Treatment with certain medication such as chemotherapy
    • Accidental injury to the heart (rare)

    Symptoms

    Symptoms vary based on age, which side of the heart is affected, the severity, and how much damage is present.
    If blood is backing up in the right side of the heart, it can cause swelling in the feet, ankles, lower legs, abdomen, or eyelids.
    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
    • Easily fatigued
    • Frequent rest breaks 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 medical history. A physical exam will be done. Your child’s doctor will check their blood pressure and heart rate.
    The heart and surrounding structures can be assessed with:
    • EKG
    • Echocardiogram
    • Chest x-ray
    • Exercise stress test
    • Cardiac catheterization
    • Biopsy
    Blood and urine tests can be done to check how other organs like the kidneys or liver are working.

    Treatment

    Heart failure treatment depends on the cause and severity. The goal of treatment is to help the heart work as well as possible and prevent complications.
    Some heart failure may be relieved with treatment of underlying conditions. This may include surgery to repair defects or time and medical support for infections.
    Treatments for heart failure often include a combination of some of the following:

    Medications

    Medications may help decrease the workload on the heart by decreasing blood pressure, helping the heart pump better, and managing excess fluid. Medication options may include:
    • ACE inhibitors—to widen blood vessels and decrease blood pressure
    • Digoxin—to help the heart pump more efficiently
    • Beta-blockers—lower blood pressure and regulate heart beat
    • Diuretics—to control swelling by removing excess fluid

    Oxygen

    Slower blood flow reduces the amount of oxygen that reaches the tissue throughout the body. Oxygen therapy will increase the amount of oxygen in the blood. This way there is more oxygen available for the tissue even if the blood flow has not improved. Oxygen therapy may include:
    • Oxygen supplement—use of a portable tank with a mask or tube that fits under the nose
    • Extracorporeal membrane oxygenation (ECMO)—blood is passed outside of the body into a machine that can work like the lungs. It is a temporary step that can give the heart and lungs a chance to rest and possibly recover from certain illnesses.

    Surgery

    Surgery may be needed to correct congenital heart disease or valve defects. In some cases, implanted devices may help support the heart. Some options include:
    • Pacemaker—to help control the natural rhythm of the heartbeat.
    • Left-ventricular assistive device (LVAD)—to help the left side of the heart pump blood to the rest of the body. Often used for those with severe failure until a heart transplant is available.
    If other treatment methods fail, 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 medications 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. Stanford Children’s Health website. Available at: http://www.stanfordchildrens.org/en/topic/default?id=heart-failure-in-children-90-P01775. Accessed March 29, 2017.

    Heart failure in children and adolescents. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/:%2520Heart-Failure-in-Children-and-Adolescents%5FUCM%5F311919%5FArticle.jsp#.WNvClm8rJQI. Updated October 6, 2016. Accessed March 29, 2017.

    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 December 19, 2016. Accessed March 29, 2017.

    Testing & diagnosis for heart failure in children. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/conditions-and-treatments/conditions/c/heart-failure/testing-and-diagnosis. Accessed March 29, 2017.

    Treatments for heart failure in children. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/conditions-and-treatments/conditions/c/heart-failure/treatments. Accessed March 29, 2017.

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