How Common Is Heart Failure in Children?

Heart failure in children is relatively rare compared to adults, but it can occur. Congenital heart defects, infections, cardiomyopathies, and other conditions may contribute to heart failure in paediatric patients. Early diagnosis and appropriate medical intervention are crucial in managing these cases. If you have specific concerns, consulting with a paediatrician or paediatric cardiologist would be advisable.

 

How is Heart Failure Diagnosed in Children?

Heart failure is diagnosed through a combination of medical history, physical examination, and laboratory tests. The severity of heart failure is determined by using these diagnostic findings, which then guide treatment decisions. However, rating the severity of heart failure in children is a challenge due to the differences in age, diagnosis, activity level, and physiology when compared to adults.

 

What Are the Common Signs And Symptoms Of Heart Failure Infants?

Infants

In infants, signs and symptoms of heart failure include:

• Shortness of breath at rest or with feeding

•         Fatigue
•         Swelling of the feet, ankles, lower legs, belly, face or neck.
•         Nausea, anorexia, poor growth or weight loss (catabolic state)
•         Fussiness (infants)
•         Poor feeding
•         Poor growth
•         Excessive sweating

Often, an infant with heart failure will:

•         Take longer to feed or lose interest in feeding soon after starting.
•         Have a rapid heartbeat that can be felt through the chest wall when sleeping or resting.
•         Not gaining weight at a healthy rate.
•         Experiences rapid or laboured breathing.

 

How Is Heart Failure in Children Diagnosed?

If your child is suspected of having heart failure, their healthcare professional will examine them for rapid or laboured breathing, swelling in their feet, ankles, and abdomen, neck veins that stick out, crackles in their lungs from fluid build-up, and irregular heartbeat or heart sounds. Additionally, a blood sample from your child may be taken to check for signs of heart failure. Imaging tests will be ordered to evaluate your child's heart if the physician suspects heart failure. These tests may include an electrocardiogram (EKG or ECG) to assess the heart rhythm, an ultrasound of the heart (echocardiogram) to evaluate heart structure and function, and a chest X-ray to determine if the heart is enlarged.

Your child may be referred to a paediatric heart specialist for imaging or additional tests, but imaging is usually done in the paediatrician’s office or clinic. The imaging process is not painful, but depending on your child's age and ability to cooperate, light sedation may be needed to obtain the clearest results.

 

What Is the Cause of Heart Failure?

Once heart failure is recognised, the next step is to identify and describe the lesion or disease process. When localising a cardiac process, it is important to determine whether the disease affects the left, right, or both ventricles.

Right and left heart diseases have distinct clinical characteristics, while biventricular disease exhibits a combination of both.

 

Right Heart Failure

This occurs when venous blood is not effectively pumped into the pulmonary circulation, resulting in a backup of fluid in the body. This causes swelling, oedema, hepatomegaly, and jugular venous distension (in older children, not infants). Ascites and pleural effusions are possible but uncommon. Examples include severe pulmonary hypertension or severe pulmonic stenosis.

Left Heart Failure

This occurs when arterial blood is not effectively pumped into the systemic circulation. Back up behind the left ventricle causes the accumulation of fluid in the lungs, leading to respiratory distress and poor cardiac output. Examples include cardiomyopathy or severe aortic stenosis.

 

Biventricular Disease

Children would exhibit a combination of the above findings. Examples include cardiomyopathy or arteriovenous malformation. Ventricular failure can be further divided into systolic and diastolic dysfunction. The former is characterised by a reduced ejection fraction and an enlarged ventricular chamber, while the latter is characterised by increased resistance to filling. Both systolic and diastolic dysfunction may coexist, as in the case of dilated cardiomyopathy, and one or both ventricles may be affected.

 

How is Heart Failure Treated in Children?

Expert panels have developed treatment guidelines for children with heart disease based on both scientific evidence and clinical expertise. It's helpful to classify patients into two groups, depending on whether heart failure is caused by over-circulation or pump failure.

 

Heart Failure Caused by Over-circulation

Over-circulation failure can be treated with medications, such as diuretics and afterload reducers. These medications can help reduce the excessive volume in your child's heart, lower blood pressure resistance, and improve the heart's ability to circulate blood. In some cases, your child's healthcare professional might recommend nutritional supplements to help your child get enough calories to counteract the effects of over-circulation. However, if medication and nutritional changes are not enough to manage the defect causing your child's heart failure, surgery might be necessary to repair the defect. If surgery is required, your child's healthcare professional will discuss the available types of surgery or other treatments with you.

 

Heart failure Caused by Pump Failure

Heart failure caused by pump failure can be treated with diuretics and afterload reducers. Surgery may be required to replace a damaged valve. A slow heartbeat can be treated with a pacemaker, while a fast heartbeat can be controlled with medications or radiofrequency ablation. In case of irreversible muscle damage, a special pacemaker, mechanical pump or ECMO can be used to improve heart function. A heart transplant may be necessary as a last resort