Heart Failure

Heart failure occurs when the heart is not working to pump blood as well as it should, and gets backed up (congested) in the blood vessels. It is also called congestive heart failure. Many people think that heart failure affects only adults, but people of all ages can have heart failure, including infants, children and teenagers.

Heart failure in children is often caused by a congenital heart defect the child is born with. In some cases, children can also develop heart failure due to infection or another medical condition.

If your child has heart failure, it may affect either side of the heart.

When heart failure affects the left side of the heart, the heart has a hard time pumping blood out to the body. This causes blood to back up into the vessels in the lungs, and the lungs become congested.

When heart failure affects the right side of the heart, it has a hard time pumping blood to the lungs. This causes blood to back up in the child’s liver and veins, which can cause fluid retention in the body.

Symptoms of heart failure may include:

• Fast breathing
• Shortness of breath or heavy breathing
• Feeling more tired than usual
• Needing to take frequent rest breaks while playing with friends
• Falling asleep when feeding or becoming too tired to eat
• Lack of appetite
• Poor growth
• Swelling of the legs, ankles, eyelids, face, or abdomen
• Nausea or vomiting
• Abdominal pain
• Cough or lung congestion
• Sweating

Heart failure can happen in children born with congenital heart defects.

Other conditions that may cause heart failure include:

• Cardiac arrhythmia (irregular heartbeats)
• Hypertension (high blood pressure)
• Diseases or infections of the heart valve, including bacterial endocarditis and rheumatic fever

If your child’s doctor suspects heart failure, he or she will ask you about your child's symptoms, get a complete medical history, and examine your child. Your doctor may order a chest X-ray to see how large the heart appears.

Your doctor may also order one or more of the following tests:

• Chest X-ray
• Echocardiogram (cardiac ultrasound)
• Electrocardiogram (ECG or EKG)
• Blood tests to help determine what caused the heart failure
• Treadmill or bicycle exercise tests can test heart function during exercise stress
• Biopsy to check for disease or infection

Treatment for heart failure will depend your child's age and the cause and severity of the condition. Treatment options may include:

• Medications to help the heart pump more effectively, to relieve congestion and edema, or to slow down the heart rate
• Ventricular assist device (VAD), a battery-operated pump that works with the heart to improve blood flow
• Surgery
• A heart transplant

The long-term outlook depends on what caused the heart failure. Some children with heart failure have a complete recovery of heart function. More often, heart failure is a chronic condition. The good news is that we have several ways of treating and controlling chronic heart failure.

The Benderson Family Heart Center at Boston Children's Hospital is the largest pediatric heart program in the United States. We provide a full range of care for heart failure, from diagnostic assessment to interventional therapy using cardiac catheterization and cardiac surgery.

Our staff includes more than 80 pediatric heart specialists who provide care for thousands of children with heart conditions each year, ranging from the simple to complex.