Heart Failure in Children

This section provides a general overview of the most common etiology, presentation, and management of heart failure in children. Details about the different etiologies can be found in respective sections in this guide.

Etiology

Common causes of heart failure:

• Neonates and infants: structural heart defects with large shunts (e.g., ventricular septal defects, atrioventricular canal defects, anomalous left coronary from pulmonary artery (ALCAPA), metabolic cardiomyopathies, congenital heart block, tachyarrhythmias)

• Older children and adolescents: cardiomyopathies (e.g., dilated, hypertrophic) (see Cincinnati Children’s Heart Encyclopedia for more details about these cardiomyopathies), myocarditis, single-ventricle circulation (failed Fontan)

• Other noncardiac causes: chemotherapy agents (especially anthracyclines), chronic kidney failure

Symptoms

Clinical symptoms and signs are related to the effects of volume overload on the heart and poor contractility.

• Neonates and infants: may present with tachypnea, tachycardia, and diaphoresis when feeding; poor feeding; or poor perfusion

• Older children: may present with progressive exercise intolerance, gastrointestinal symptoms (e.g., abdominal pain, nausea, and vomiting), lethargy, and edema

Management

• Medical therapies: mainstays of medical management include diuretics, beta-blockers, digoxin, afterload reduction (angiotensin-converting-enzyme [ACE] inhibitors such as lisinopril and angiotensin-receptor blockers such as losartan), cardiac-remodeling agents (spironolactone), and combinations of these agents

• Advanced therapies: for those who need cardiac support beyond medical therapy, include ventricular assist devices (VADs) and ultimately heart transplant