Definition

The heart is an organ composed of muscles that pump oxygen- and nutrient-rich blood throughout the body. In cases of heart failure, the heart loses or decreases its ability to pump this oxygenated blood efficiently to meet the body’s needs.

Deoxygenated blood containing carbon dioxide from the body is received by the right atrium and sent to the lungs via the right ventricle. In the lungs, carbon dioxide is exchanged for oxygen, and the oxygenated blood returns to the heart, entering the left atrium before being pumped to the rest of the body via the left ventricle.

In heart failure, blood and fluid may back up into the lungs, a condition known as congestive heart failure. This prevents various parts of the body from receiving adequate oxygen-rich blood to function normally. These are some of the symptoms of heart failure. Heart failure typically refers to a progressively worsening condition in which the heart's function deteriorates over time.

Most cases of acute heart failure in children are associated with underlying medical conditions and congenital heart disease that commonly cause heart failure. Approximately 20% of children with congenital heart disease will develop heart failure. Many children with these conditions require surgery early in life, with an estimated 1-2 per 1000 live births resulting in heart failure as a complication.

Read more: Acute Heart Failure in Adults

Causes

Several factors can lead to heart failure in children, the most common being congenital heart disease present at birth. Other causes include cardiomyopathy, a disease that affects the heart muscle and is often hereditary, and ischemia (reduced blood flow to the heart), which is rare in children. Additionally, heart valve diseases, arrhythmias (irregular heartbeats), anemia, infections, and side effects from medications, particularly chemotherapy drugs, can contribute to heart failure in children.

Risk Factor

Recognizing the risk factors is crucial for preventing and managing heart failure in children. Common risk factors include:

• Alcohol consumption during pregnancy
• Smoking during pregnancy
• Genetic factors

Medical conditions such as hypertension, dyslipidemia, metabolic syndrome, and lack of physical activity in children can also increase the risk of developing acute heart failure.

Symptoms

Symptoms of heart failure in children can vary but often include:

• Swelling in the feet, ankles, lower legs, abdomen, liver, and neck veins
• Difficulty breathing, especially during activity, such as rapid breathing or wheezing
• Excessive coughing
• Difficulty feeding
• Poor weight gain or weight loss
• Fatigue
• Excessive sweating during feeding, playing, or exercising
• Irritability in infants

In older children, symptoms may include:

• Weight loss
• Fainting or loss of consciousness
• Chest pain

The severity of the symptoms depends on how much the heart’s pumping ability is affected. These symptoms can resemble other medical conditions, so it’s important to see a doctor for a proper diagnosis and treatment.

Diagnosis

The diagnosis of heart failure in children is a diagnosis that can be established through a medical interview, physical examination, and supporting examinations if available and necessary to be carried out.

During a medical interview, the doctor will inquire about the patient's current symptoms. The symptoms that exist can point to a specific disease, so you must express them as completely as possible, along with when the symptoms first appeared. This information is necessary for doctors to make a specific medical diagnosis. If the symptoms indicate heart failure, the doctor will proceed with a physical examination and further examinations.

During a physical examination, the doctor will conduct an examination based on the patient's symptoms in order to identify several clinical signs, which are objective signs obtained by the doctor during the examination.

In cases of acute heart failure, doctors may notice swelling in the legs along with a rapid breathing rate. If the clinical signs indicate heart failure, the doctor will proceed with supporting examinations if the equipment is available and required.

Establishing or validating the diagnosis of heart failure also involves additional examinations. Echocardiography can evaluate the movement of the valves and heart chambers and can also detect changes that arise from heart failure, such as enlarged heart chambers; chest X-rays can show changes in the shape of the heart and lungs; electrical heart recording (ECG) can evaluate changes in electricity and heart rhythm; and cardiac catheterization can be performed to measure pressure and oxygen levels in the heart if necessary. Additional examinations, such as blood tests and urine tests, can be performed and, if the results are poor, can help diagnose heart failure.

Management

Children with heart failure receive different treatments based on their age, overall health, and symptoms. The severity of the heart failure at the time will also determine the course of treatment. Surgery to correct a congenital heart defect can treat heart failure if it is the cause of the condition. Medications that affect heart rhythm, the removal of excess water from the body to enable frequent urination, the widening of blood vessels and the reduction of blood pressure, and medications that alter heart rate and blood pressure to facilitate the heart's pumping of blood throughout the body are all commonly used to treat heart failure in children.

Furthermore, there are a number of treatments available, including cardiac resynchronization therapy for chronic pediatric heart failure, pacemaker use when the heart fails to pump adequately due to a slow heart rate, and, if required, heart transplantation.

Children should also speak with a nutritionist about nutrition-related issues like eating disorders and water intake management. If feasible, sports rehabilitation programs can also help older children recover.

Complications

Potential complications of heart failure include:

• Delayed growth and development
• Irregular heart rhythms (arrhythmias)
• Blood clots, which can lead to stroke
• Kidney or liver damage
• Anemia (low red blood cell count)

Prevention

There is no specific way to prevent heart failure in children. However, monitoring symptoms, attending regular checkups, and following medical advice can help manage the condition and prevent complications.

When to See a Doctor?

If your child’s symptoms worsen, including difficulty breathing, swelling in both legs, fatigue, or trouble eating, it is important to consult a pediatric cardiologist or a pediatrician. The doctor will conduct a thorough medical history, physical examination, and necessary diagnostic tests to identify the underlying condition and provide appropriate treatment.

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