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My Child Has:
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Congestive Heart Failure
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Congestive heart failure (CHF) is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body's other organs. The heart keeps pumping, but not as efficiently as a healthy heart. Usually, the loss in the heart's pumping action is a symptom of an underlying heart problem. See About the Heart and Blood Vessels for more information on how the heart normally works.
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Congestive heart failure often occurs in children with congenital (present at birth) heart defects. Other medical problems that can cause CHF include, but are not limited to, the following:
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- Heart valve disease caused by past rheumatic fever or other infections.
- Infections of the heart valves and/or heart muscle (i.e., bacterial endocarditis).
- heart valve malfunctions such as regurgitation (improper valve closure) or stenosis (narrowed valve opening).
- Cardiac arrhythmia (irregular heartbeats).
- Cardiomyopathy, or another primary disease of the heart muscle.
- Chronic lung disease.
- Anemia.
- High blood pressure (hypertension).
- Hemorrhage (excessive bleeding).
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Congestive heart failure can affect the right side of the heart, the left side of the heart, or both sides.
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When the right side of the heart begins to function less efficiently, it is unable to pump much blood forward into the vessels of the lungs. Because of the congestion in the right side of the heart, blood flow begins to back up into the veins. Eventually, swelling (edema) is noticed in the feet, ankles, eyelids and abdomen due to fluid retention.
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When the left side of the heart fails, it is unable to pump blood forward to the body efficiently. Blood begins to back up into the vessels in the lungs, and the lungs become stressed. Breathing becomes faster and more difficult. The body does not receive enough blood to meet its needs, resulting in fatigue and poor growth.
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The following are the most common symptoms of CHF. Each child may experience symptoms differently. Symptoms may include:
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- visible swelling of the legs, ankles, eyelids, face and (occasionally) abdomen
- fast breathing during rest or exercise
- shortness of breath or labored breathing
- fatigue
- need to take frequent rest breaks while playing with friends
- nausea
- abdominal pain, vomiting
- falling asleep when feeding or becoming too tired to eat
- lack of appetite
- weight gain, even when the appetite is poor
- failure to thrive
- cough and congestion in the lungs
- sweating
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The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been affected.
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The symptoms of CHF may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
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Your child's physician will obtain a complete medical history and physical examination, asking questions about your child's appetite, breathing patterns and energy level. Other diagnostic procedures for CHF may include:
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- Blood and urine tests.
- Chest X-ray — A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.
- Electrocardiogram (ECG or EKG) — A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias) and detects problems with the heart muscle.
- Echocardiogram (echo) — A noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.
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Specific treatment for CHF will be determined by your child's physician based on:
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- your child's age, overall health and medical history
- extent of the disease
- your child's tolerance for specific medications, procedures or therapies
- how your child's doctor expects the disease may progress
- your opinion or preference
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If heart failure is caused by a congenital (present at birth) heart defect or an acquired heart problem such as rheumatic valve disease, surgical repair of the problem may be necessary. Medications often are helpful in treating CHF initially. Eventually, medications may lose their effectiveness, and many congenital heart defects need to be repaired surgically.
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Medications also may be used after surgery to help the heart function during the healing period. Medications that are commonly prescribed to treat CHF in children include the following:
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- Digoxin — Helps strengthen the heart muscle, enabling it to pump more efficiently
- Potassium-sparing Diuretics — Helps the body retain potassium, an important mineral that is often lost when taking diuretics
- Potassium supplements — Replaces the potassium lost when taking diuretics
- ACE (angiotensin-converting enzyme) Inhibitors — Dilates the blood vessels, making it easier for the heart to pump blood forward into the body
- Beta-blockers — Used to decrease the workload of the heart by slowing it down and decreasing BP
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Cardiac resynchronization therapy, or device therapy, is a newer treatment for heart failure. Device therapy uses a type of pacemaker that paces both sides of the heart simultaneously to coordinate contractions and improve pumping ability.
For more specific information regarding treating CHF, consult your child's physician.
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Complementing the Cardiovascular Program of Children's Hospital Boston is the nation's most intensive clinical and basic research program focused on pediatric heart disease. Children's is a world leader in opening new avenues of "translational research," bringing laboratory advances to the bedside and doctor's office as quickly as possible. All senior medical staff members of the Cardiovascular Program participate in clinical research activities
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Contact Children's Hospital Boston Cardiovascular Program physicians for a second opinion.
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