Heart Failure in Children
Heart failure doesn’t mean the heart isn’t working at all—it means the heart isn’t pumping blood properly. Structural problems can make it hard for the heart to fill with enough oxygenated blood. Or heart muscle weakness can prevent the heart from pumping forcefully enough to circulate blood to the body.
When the heart isn’t pumping properly, the body doesn’t get enough oxygenated blood. Lack of oxygen makes it hard for your child’s body to grow and function. The good news is some types of heart failure respond well to treatment.
Pediatric Heart Failure Causes and Risk Factors
Heart failure has different causes in children and adults. The two most common causes of heart failure in children are:
- Over-circulation failure: Oxygen-poor blood mixes with oxygen-rich blood. This mixing creates blood that doesn’t have enough oxygen, which the heart pumps throughout the body. Because the body isn’t getting enough oxygen, the heart pumps even harder. This extra work stresses the heart. Some congenital heart defects cause holes between the heart chambers, allowing the oxygen-rich and oxygen-poor blood to mix inside the heart. An arteriovenous malformation (AVM) can cause oxygen-rich and oxygen-poor blood to mix elsewhere in the body.
- Pump failure: The heart doesn’t pump strongly enough to circulate the oxygen-rich blood throughout the body. Infection, coronary artery problems and certain drugs can cause pump failure.
Pediatric heart failure risks
Risk factors for heart failure include:
- Heart conditions, including arrhythmia (irregular heartbeat), congenital heart defects, high blood pressure or valve problems
- Heart muscle disease, such as cardiomyopathy, myocarditis or inflammation after viral infections like COVID-19
- Other chronic medical conditions, like diabetes, lung disease or overactive thyroid
- Some medications, especially certain chemotherapy drugs
Heart Failure Symptoms
Symptoms of heart failure in children include:
- Trouble breathing
- Feeding problems (in infants)
- Poor growth
- Excessive sweating
- Low blood pressure
Heart Failure Diagnosis
Doctors rely on family history, patient symptoms, a physical exam and diagnostic tests to diagnose heart failure. Tests may include:
- Chest X-ray to see if your child’s heart is too big
- Echocardiogram to look at your child’s heart structure and function
- Electrocardiogram (EKG) to see your child’s heart rhythm
- Exercise (stress) test to evaluate heart-lung function
- Cardiac catheterization to see the amount of blood flow the heart is producing, and the pressures in the chambers of the heart.
Heart Failure Treatment
Treatment varies based on several factors, including what caused the heart failure and your child’s age and symptoms. Heart failure treatments include:
- Medication: Doctors may prescribe diuretics (water pills) to eliminate excess fluid, and specific heart failure medications. This includes ACE inhibitors, sacubitril/valsartan or beta blockers to heart muscle function, or digoxin to help the heart pump more strongly.
- Dietary changes: Over-circulation causes your child’s body to use more energy. Doctors may prescribe nutritional supplements to help your child receive enough calories to meet the increased energy need. A low-salt diet also can help by lowering blood pressure.
- Pacemaker/ICD: For pump failure caused by a slow heartbeat, doctors can implant a pacemaker, a tiny battery-operated device, to regulate your child’s heart rate.
- Surgery to correct congenital heart defects: For heart failure caused by a heart defect, surgery to fix the heart structure may cure the heart failure. Examples of these defects include an atrial septal defect (ASD) or ventricular septal defect (VSD).
- Mechanical support: For heart failure caused by irreversible heart damage, mechanical support can temporarily relieve stress on your child’s heart and improve heart function. A ventricular assist device (VAD) is an implantable battery-operated device that helps the left ventricle pump oxygenated blood to the body. Extracorporeal membrane oxygenation (ECMO) is a machine that oxygenates blood to help with lung and heart function
- Heart transplant: If all other treatments fail, doctors may consider a heart transplant. A heart transplant gives your child a new, healthy heart from an organ donor.
Heart Failure Care at Children’s Hospital Los Angeles
At CHLA, your child receives excellent care from world-class experts. Learn more about our Pediatric Cardiomyopathy and Heart Failure Program.