Guide to Pediatric Heart Failure

Heart failure, often called congestive heart failure (CHF), is a term used by cardiologists to describe a patient whose heart does not pump enough blood out to the rest of the body to meet the body's demand for energy.

Heart failure can be the result of either a heart that pumps well but is very insufficient (due to a structural problem), or of a weak heart muscle that does not pump a normal amount of blood to the body.

Symptoms are different for children of different ages.

Symptoms in Infants
In infants, symptoms may include:

• Difficulty breathing as the lungs fill with fluid
• Harder/slower at eating
• Becoming sweaty during feedings
• Sleeping more, though this is difficult to gauge as different babies have different sleeping habits

Symptoms in Older Children
Symptoms in older children are usually related to their inability to tolerate exercise. They become short of breath more quickly compared to their peers and need to rest more often.

In children with heart failure, passing out during exercise may be very serious and needs to be evaluated immediately. Appetite may be poor when heart failure is severe and weight loss or lack of weight gain can be seen even in older children.

Some children will retain fluid and will actually gain weight with heart failure and appear puffy. As it is harder to determine parameters for heart failure in older children, it is important to look for change in exercise capabilities or progression of symptoms with time.

Diagnostic testing for heart failure can include:

• An electrocardiogram to indicate if the chambers of the heart are enlarged or point to specific congenital heart diseases or rhythm disturbances that can cause heart failure.
• A chest X-ray to determine if the heart is enlarged and if there is extra blood flow or fluid in the lungs. This can be very important in determining the progression of congestive heart failure.
• A graded exercise test to follow progression of heart failure in some instances for older children.
• An echocardiogram to confirm the diagnosis of structural problems of the heart, and evaluate the function of the heart muscle.
• Sometimes a cardiac catheterization must be performed to further investigate the function of the heart.
• Cardiac magnetic resonance, or an MRI of the heart, provides exquisite detail about the structure, function, and composition of the heart. This test can contribute unique information not given by other imaging techniques, and can even be used to perform virtual surgery in the case of implanting support devices.

Treatment can vary with age and type of disease. Treatment options can include:

Medication
Medication can be used as a temporary solution to give the heart time to heal or grow before a surgery or transplant. Sometimes certain problems can be controlled with medication.

Transplant
Heart transplantation is considered as a last resort for patients with end-stage heart disease who may have no other surgical or medical therapies available. The goal of heart transplantation is to return the patient to a state of functionality with the best quality of life possible.

Ventricular Assist Device
A Ventricular Assist Device (VAD) is a small pump that sits inside or outside the body and does the job of the heart when the heart is too sick to pump. A VAD can be either a long-term treatment or an option while a child waits on a transplant.