Congestive heart failure

Congestive heart failure (CHF) is a condition in which the heart has to work harder than normal to get blood to the body resulting in symptoms. It actually is not a specific diagnosis but rather a collection of symptoms that can be the result of a variety of different heart problems.

Most commonly, CHF in children is caused by structural heart problems. 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 (often through a hole) passes back to the right side of the heart and goes through the lungs again instead of going out to the body. Children also can have CHF due to weakness of the heart muscle itself. Treatment depends on the specific problem.

What causes congestive heart failure?

  • 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)

How does congestive heart failure affect the body?

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.

What are the symptoms of congestive heart failure?

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

  • Failure to gain weight in infancy. Some babies will have normal length, but low weight for age
  • Shortness of breath or labored breathing
  • Fatigue
  • Needing to take frequent rest breaks while playing with friends
  • Falling asleep when feeding or becoming too tired to eat during infancy
  • 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.

How is congestive heart failure diagnosed?

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 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.

Treatment of congestive heart failure:

Specific treatment for CHF will be determined by you and your child's 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

Since causes and symptoms of CHF can vary, diagnosis and treatment from an experienced pediatric cardiac team will lead to the best treatment outcomes. Children’s Hospital is one of the country’s most experienced and busiest pediatric heart surgery centers. Learn more.