Cardiac Failure

Parent Information

Introduction

Heart failure is a serious medical condition that occurs when the heart does not pump enough blood to the body to support normal function. This can be due to either a heart that pumps well but is very insufficient (due to a structural problem or blockage) or it can be due to a weak heart muscle that is not strong enough to pump a normal amount of blood to the body. If the left side of the heart is affected, this will lead to a backup of blood and fluid into the lungs. If the problem is on the right side the backup of blood and fluid will be into the liver and veins (legs). Both sides of the heart may fail at the same time and would cause a combination of the above problems.

There are two main categories of causes of congestive heart failure.

The first category is more common in babies and younger children. In this situation, the heart muscle pumps well, but there is a birth defect that causes changes in the pattern of blood flow that is inefficient. Instead, too much blood goes to the lungs and makes the lungs stiff and heavy. Examples of birth defects include holes or abnormal blood vessel connections (see below).

A patent ductus arteriosus is a blood vessel that connects the aorta and main pulmonary artery. The blood vessel is required in fetal life but should resolve after birth. Failure of large PDAs to close is common in premature infants and these may require repair.

A large ventricular septal defect is a hole between the two lower pumping chambers of the heart. The hole allows too much extra blood flow to go to the lungs. Both the heart and lungs are forced to work harder.

The second cause for congestive heart failure is when the heart muscle is not strong enough to pump efficiently. More common for older children and is rare in infants. This can be due to a severe blockage in the heart such as with a heart valve or blood vessel. Blood cannot effectively go to the body so it backs up in the lungs. Examples include critical aortic stenosis, or coarctation of the aorta, or severe congenital heart disease (hypoplastic left heart syndrome).

Sometimes the heart is born weak or it becomes weak over time. This can be caused by a problem inherited in the family, toxins, abnormal heart rhythms, or infections.

Symptoms of Heart Failure

Symptoms are different for children of different ages. In babies, most commonly exhibit breathing problems and poor growth. As the lungs fill with fluid, it is hard to breathe and babies use other muscles of their chest and belly to help overcome the stiff lungs. They have a harder time eating and they may sweat. Babies may fall asleep during feeds. Over time they may lose weight.

Older children with congestive heart failure may be short of breath or fatigued with exercise. Sometimes the main feel dizzy or faint. They may have stomach discomfort and poor appetite.

While it would seem that most children would lose weight with heart failure, will retain fluid and gain weight and appear puffy.

Diagnosis:

To diagnose heart failure, your doctor will perform a check-up along with some laboratory testing. There are certain clues they will be looking for. Height and weight will be assessed to check for growth. The doctor will test for fast heart and breathing rates and low blood pressure.

The doctor will listen for abnormal heart sounds such as a murmur or gallop as well as evidence of fluid in the lungs. The liver may be enlarged due to fluid back up. The face or legs ay be puffy due to fluid back up.

A chest X-ray can tell if the heart is enlarged and if there is extra fluid in the lungs.

An echocardiogram is an ultrasound of the heart that the diagnosis of structural problems and the function of the heart.

EKGs may be done if there is a heartbeat problem.

Other tests may include a cardiac MRI, CT, or catheterization- each can help assess both structure and function of the heart.

Treatment

Some infants or children require a surgical intervention to cure their heart disease. They may require medicines before and or after their intervention. There are several types of medications used to treat congestive heart failure.

A diuretic like Lasix helps the kidneys to eliminate extra fluid in the body.

If the heart is weak, medicines to lower the blood pressure are used (ACE inhibitor, beta-blockers). These seem to make it easier for the heart to pump blood to the body. Digoxin is used to help make the heart squeeze better, and help pump blood more efficiently.

Sometimes babies will need to have extra nutrition given to them either by the bottle or via a tube that goes directly from the nose to the stomach. Older children may require this as well.

Some kids may also need restriction of certain kinds of exercise and sports but light activity is usually ok

All outcomes depend on the cause of the heart problem. If heart failure is due to a structural problem or birth defect, it can either be partially or completely fixed. Many children have normal lives after that.

Cardiomyopathy in an older child tends to progress unless the cause is reversible. Some of these children will require a heart transplant.

Working together with your doctor, taking prescribed medicines, leading a healthy lifestyle, and asking questions are the best ways to help children with heart disease.