Heart Failure

Heart failure is a condition in which the heart can’t pump enough blood to meet the body’s needs. Usually, this happens because the heart muscle is too weak to “squeeze” out enough blood with each beat, but it can also happen if there is a defect that causes old and new blood to mix inside the heart, or if a valve is not working properly.

Heart failure is found most often in older people, but it can happen to anyone at any age, including children. It’s a serious condition — and also quite common. Many people with heart failure continue to have a full and active life for many years after their diagnosis.

Symptoms of heart failure vary based on the type of heart failure your child has. Since heart failure is often caused by other illnesses, injuries, or diseases, your child might also have symptoms of those conditions as well. Common symptoms include:

• Shortness of breath
• Cough
• Feeling very tired and weak
• Weight gain (from fluid buildup)
• Swollen ankles, feet, belly, lower back, and fingers
• Puffiness or swelling around the eyes
• Trouble concentrating or remembering

The main cause of heart failure (heart muscle damage and weakness) cannot be cured, but symptoms can be managed. Good treatment and self-care can help keep your child’s symptoms from getting worse.

Take your child to see a doctor if they show any of the early signs of heart failure, including the symptoms listed above. Sometimes, these symptoms can be caused by other serious illnesses or diseases besides heart failure that your child’s doctor can diagnose or rule out.

Heart failure can be caused by anything that damages and weakens the heart muscle. In children, common causes of heart failure include:

• Congenital [KAHN-jen-ih-TUHL] heart defects. Sometimes, a child’s heart doesn’t develop the right way. This can happen because of a genetic mutation, inherited disorder, or a random event during pregnancy. Some heart defects don’t cause serious problems, but others can cause arrhythmias or even heart failure.
• Heart valve problems. Heart valves control the one-way flow of blood through your heart. If valves are damaged or abnormal, your heart has to work harder to move blood throughout your body.
• Myocarditis [my-oh-kar-DYE-tis]. The muscles in your heart can get inflamed, which can make them work less well. If this inflammation gets severe the heart might stop working altogether.
• Arrhythmias [uh-RITH-mee-uhs]. Sometimes, the heart beats too fast, too slow, or without a regular rhythm. Most arrhythmias don’t lead to heart failure, but they can in severe cases.

The doctor will look at your child’s symptoms, any other medical conditions they might have, and how those conditions are treated. Your child’s heart team will also ask you about your child’s daily life, and will want to know if any other members of your family have had heart problems, especially heart problems at a young age. Finally, they will order several tests that will help them figure out what’s causing your child’s symptoms. Some of those tests are:

• Blood tests, to count your red blood cells (RBC), check your child’s electrolytes (minerals such as calcium, magnesium, and potassium in the blood), and to see if their kidneys, liver, and thyroid are working well.
• Urine tests, to see if problems with your child’s kidneys or bladder may be adding to your heart failure.
• Chest x-rays, to check the size of your child’s heart and compare it against what’s expected at their age. Chest x-rays can also look for fluid buildup in the lungs, which can be a sign of heart failure or another disorder.
• Electrocardiogram [ih-LEK-trow-KAR-dee-oh-GRAM] (ECG or EKG), to check the electrical activity of your child’s heart. Electrical problems can make the heart beat the wrong way or stop working altogether.
• Stress tests, to see how your child’s heart responds to stress. Exercise or certain medicines may be used to stress their heart.
• Echocardiogram [eh-koh-KAR-dee-oh-GRAM] (echo), or ultrasound, to create images of your child’s heart. An echo can tell your provider how well their heart is pumping, if their heart valves are working well, and how much their heart is enlarged or underdeveloped. Echos are often used to measure your ejection fraction (EF). EF is a measure of how much blood is pumped with each heartbeat.
• Angiogram [ANN-gee-AW-gram], to see how blood flows through your child’s heart. An angiogram is done in a cardiac catheterization lab. During the test, a long, thin tube called a catheter is inserted through a blood vessel and guided into the heart. Dye is injected through the catheter, and special x-rays track how blood flows towards and away from your child’s heart. This test is also used to diagnose coronary artery disease, or atherosclerosis, which is a cause of heart failure.

If your child is diagnosed with heart failure, you and your child’s heart team will create a plan to help keep their condition from getting worse. You get to help decide what that plan looks like. However, there are 5 important steps you can take that will help your child live the healthiest life possible. We call this the MAWDS-HF plan:

• Help your child take their medicines as prescribed. Young children might need help taking medicine, or they might need another form of medicine that’s easier for them to take. Water pills can help manage fluid build-up. Other medicines will help improve their condition.
• Encourage your child to be active in some way, every day. When your child’s heart is strong, it works better and is less likely to fail again.
• Check your child’s weight every day, and write it down. Do this at the same time each day, wearing the same clothes, to better see how their body is changing from day to day.
• Change your child’s diet by giving them less sodium (salt) in all foods combined and by giving less than 64 ounces (1/2 gallon) of liquid each day.
• Know your child’s symptoms and when to call their doctor for advice.

Besides these 5 steps, your child’s care team will help you manage any other medical conditions that may make their heart failure worse. These providers may also recommend additional procedures or treatments to support the treatment of your child’s heart failure, such as cardiac rehab.

To manage heart failure well, you might need to make changes to your child’s daily routines and learn new ways to help them manage their health. These changes will be written out for you in your child’s heart failure action plan. Together, you and your care team will decide what those changes need to be and how you can work them into your child’s life with as little disruption as possible.

In children, the causes of heart failure are harder to avoid, since they are usually congenital (present from birth). In this case, the best approach is to keep an eye on your child’s health and take them to the doctor if they show signs of heart failure. Early detection and treatment can limit damage to the heart and help your child stay healthy.

American Heart Association

Heart failure is when your child’s heart doesn’t pump enough blood because it is too weak or it has an injury or defect that keeps it from working properly. There are many tests to help diagnose heart failure. Treatment is focused on limiting damage to the heart and keeping your child healthy as healthy as possible.