Congestive Heart Failure (CHF)

What is congestive heart failure (CHF)?
Congestive heart failure (CHF) is a condition in which the heart cannot effectively meet the oxygen needs of the body's other organs. It actually is not as much a specific diagnosis but rather a collection of symptoms that can be the result of a variety of different heart problems.

The most common type of CHF is seen in adults and usually occurs after an injury to the heart, for example, myocardial infarction (heart attack). In this form of CHF, the primary abnormality is that the pumping action of the heart is not effective.

Watch Dr. Berger talk about the Herma Heart Center.

There are two functional parts to the heart's pumping ability. Disturbance of either or both can lead to symptoms of CHF. The most obvious is the actual squeezing action of the heart muscle (contracting) that pushes blood to the rest of the body. This is called systolic function. The second part occurs in between contractions when the heart relaxes such that blood returning from the body and lungs can easily fill the heart. This is called diastolic function. Both systolic and diastolic function problems can cause symptoms of CHF. Many different medical conditions can affect the heart's pumping ability. The symptoms and treatments of these illnesses can vary dramatically. Some affect only the heart and others affect the whole body.

The most common type of CHF in children is caused by a structural abnormality in the heart and may not affect the pumping action. Heart defects that allow too much blood to flow to the lungs can cause CHF. These are called left to right shunt problems because blood from the left side of the heart is allowed (often through a hole) to pass back to the right side of the heart and go through the lungs again instead of going out to the body. Children (like adults) also can have CHF due to weakness or abnormality of the heart muscle. Many things can cause this and treatment depends on the specific problem.

• Various forms of congenital heart disease such as ventricular septal defect (VSD), patent ductus arteriosus (PDA) or common AV canal.
• Heart valve disease caused by past rheumatic fever or other infections.
• Infections of the heart valves and/or heart muscle (endocarditis).
• Cardiac arrhythmias (irregular heartbeats).
• Cardiomyopathy or another primary disease of the heart muscle.
• Coronary artery disease.
• Kawasaki's disease.
• Inflammation of heart muscle (myocarditis).

Congestive heart failure can affect the right side, left side or both sides of the heart.

When the right side of the heart begins to function less efficiently, it is unable to pump much blood 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 may be noticed in the feet, ankles, eyelids and abdomen due to fluid retention. These symptoms are much more common in adults with CHF than in children. In children, congestion in the liver often is a better measure of right-sided failure than visible signs of swelling.

When the left side of the heart fails, it is unable to pump blood 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. Also, the body does not receive enough blood to meet its needs, resulting in fatigue and poor growth. In babies, most symptoms may occur with feeding or crying when the infant may have labored breathing and sweating.

Following are the most common symptoms of congestive heart failure. However, each child may experience symptoms differently. Symptoms may include:

• Failure to gain weight. Some children will have normal height, but low weight for age.
• Visible swelling of the legs, ankles, eyelids, face and (occasionally) abdomen.
• Fast breathing during rest, feeding or exercise.
• Shortness of breath or labored breathing.
• Fatigue.
• Needing to take frequent rest breaks while playing with friends.
• Nausea.
• Falling asleep when feeding or becoming too tired to eat.
• Cough and congestion in the lungs.
• Sweating.

The severity of the condition and symptoms depends on whether and how much of the heart's pumping capacity has been affected and/or how much extra blood is going to the lungs.

The symptoms of CHF may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

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:

• Blood and urine tests.
• Chest X-ray - a diagnostic test which 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. This can very effectively show both the structure and function of the heart.

Specific treatment for CHF will be determined by you and your childÕs physician based on:

• Your child's age, overall health and medical history.
• Extent, type and typical history of the disease.
• Your child's tolerance for specific medications, procedures or therapies.

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 will need to be repaired surgically. Medications also may be used after surgery to help the heart function during the healing period.

Medications that commonly are prescribed to treat CHF in children include the following:

• Digoxin - helps strengthen the heart muscle, enabling it to pump more efficiently.
• Diuretics - help the kidneys remove excess fluid from the body.
• Potassium-sparing diuretics - help the body retain potassium, an important mineral that often is lost when taking diuretics.
• ACE (angiotensin-converting enzyme) inhibitors - dilate the blood vessels, making it easier for the heart to pump blood forward into the body.
• B-blockers - help prevent the heart from working too hard to compensate and improves some of the body's counter-productive responses to the stress of heart failure.

For more specific information regarding treating CHF, consult your child's physician.