Congestive Heart Failure In Children

Overview, Causes, & Risk Factors

Congestive heart failure is a condition in which the heart cannot adequatelypump blood. Because the pumping action of the heart is reduced, blood backs upinto certain body tissues, causing fluid buildup.

What is going on in the body?

Congestive heart failure is caused by a variety of complex problems thatcause the pumping chambers of the heart to fail.

The heart is divided into a left heart and a right heart. The blood receivesoxygen as it passes through the lungs. The left heart receives blood fromthe lungs and pumpsthis oxygen-rich blood to the organs, muscles, and tissues of the body. Theright heart receives oxygen-poor blood from these organs and tissues. It thenpumps it to the lungs to receive a fresh supply of oxygen.

If the pumping chambers of the heart do not function properly, blood stays inthe lungs or in the tissues of the body. This leads to congestion of theseareas with blood and fluid, the reason for the term congestive heart failure.The organs and tissues do not receive an adequate supply of blood, and theybegin to suffer the effects.

What are the causes and risks of the condition?

The most common cause of congestive heart failure in children is congenital heart disease, including:

  • cardiac malformations, such as tetralogy of Fallot
  • abnormalities of the heart valves
  • underdevelopment of one or both ventricles
  • coarctation of the aorta, whichis a narrowing of the vessel bringing blood to the heart
  • ventricular septal defects, orholes in the walls that separate the left and right sides of the heart
  • patent ductus arteriosus, or anabnormal connection between the aorta and the pulmonary artery that mixesoxygenated and unoxygenated blood
  • Other causes of congestive heart failure in children include:

  • rheumatic heart disease, caused by damage to the heart from group A strep infections
  • bacterial endocarditis, orinflammation of the lining of the heart due to an infection
  • myocarditis, or inflammation ofthe heart muscle
  • complications of open heartsurgery
  • chronic anemia, which resultsin a lowred blood cell count
  • poor nutrition
  • drug toxicity
  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Most of the time, congestive heart failure occurs quickly in children. Failureof both ventricles is common. This causes a combination of symptoms, including:

  • shortness of breath
  • rapid breathing
  • a rapid heartbeat
  • coughing and wheezing
  • irritability
  • failure to thrive,meaning that the child’s growth and weight gain are slower than expected
  • excessive sweating
  • loss of appetite
  • swelling of the hands and feet
  • pain and tenderness of the abdomen
  • coolness of extremities to the touch
  • grayish tint to the skin
  • Diagnosis & Tests

    How is the condition diagnosed?

    Congestive heart failure is diagnosed on the basis of the child’smedical history and physical exam. Identification of the underlying disease mayrequire special tests, including:

  • electrocardiogram, or ECG,which graphs the electrical activity of the heart
  • chest X-ray, which may reveal anabnormally enlarged heart
  • echocardiography, which usesultrasound waves to provide information about the structure, function, andmotion of the heart
  • cardiac catheterization, whichinvolves injection of a contrast agent to allow the doctor to watch the bloodflow through the heart and its arteries
  • Prevention & Expectations

    What can be done to prevent the condition?

    Prompt treatment of the underlying disease can lower the child’s risk ofdeveloping congestive heart failure. Maintaining a healthy body weight,including physical activity in everyday life, and eating a diet designed to minimize heart disease can helpminimize congestive heart failure.

    What are the long-term effects of the condition?

    If untreated, congestive heart failure in children can lead to early death.Long-term effects may include delays in the child’s development and permanentdamage to organs such as the brain, liver, and kidneys.

    What are the risks to others?

    Congestive heart failure is not contagious and poses no risk to others.

    Treatment & Monitoring

    What are the treatments for the condition?

    Congestive heart failure in children can sometimes be diagnosed when the babyis still in the womb. If this is the case, the mother can be treated withmedications and water pills. This may help lessen the effect on the baby.

    After the baby is born, general treatment measures will include giving oxygen, limiting sodium in the diet, and treating underlying anemia. A heart medication calleddigitalis can be used to help improve the efficiency of the heart. Water pillshelp relieve some of the pressure on the heart by removing extra fluid.

    In severe cases, stronger heart medications can be used to help the heart pumpwith more forceful contractions. Medications that relax the blood vessels canalso be used. If the cause of CHF is congenital heart disease, openheart surgery may be done.

    What are the side effects of the treatments?

    Heart medications used in the treatment of CHF can have serious side effects.Digitalis must be used carefully to avoid toxic effects. Water pills can causeexcessive dehydration andsalt imbalances. Surgery can causebleeding, infection, and allergicreactions to anesthesia.

    What happens after treatment for the condition?

    Treatment of the underlying condition often eliminates the congestive heartfailure. If a structural defect is the cause of the CHF, open heart surgery can restore normal blood flow in thebody. However in some cases, long-term medical treatment is required.

    Once the acute medical problem is resolved, a child with congestive heartfailure should be encouraged to reduce coronary risk factors. This may include control of other diseases suchas diabetes and high blood pressure, as well as eating a healthy diet for heart disease.

    How is the condition monitored?

    Monitoring varies, depending on the underlying cause of the congestive heartfailure. Blood tests, such as a CBCor complete blood count, can track the treatment of anemia. Kidney function tests and liver function tests help to detect any damage frommedications used to treat CHF. Any new or worsening symptoms should be reportedto the health care provider.

    Article type: xmedgeneral