Congestive Heart Failure In Children
Congestive heart failure (CHF) is a condition in which the heart cannot adequately pump blood. Because the pumping action of the heart is reduced, blood backs up into certain body tissues, causing fluid buildup.
What is going on in the body?
Congestive heart failure is caused by a variety of complex problems that cause the pumping chambers of the heart to fail. The heart is divided into a left heart and a right heart. The blood receives oxygen as it passes through the lungs.
The left heart receives blood from the lungs and pumps this oxygen-rich blood to the organs, muscles, and tissues of the body.
The right heart receives oxygen-poor blood from these organs and tissues and pumps it to the lungs to receive a fresh supply of oxygen.
If the pumping chambers of the heart do not function properly, blood stays in the lungs or in the tissues of the body. This leads to congestion of these areas with blood and fluid, the reason for the term congestive heart failure. The organs and tissues do not receive an adequate supply of blood, and they begin to suffer the effects.
What are the causes and risks of the condition?
The most common cause of congestive heart failure in children is congenital heart disease, including:
cardiac malformations, such as tetralogy of Fallot
abnormalities of the heart valves
underdevelopment of one or both ventricles
coarctation of the aorta, which is a narrowing of the vessel bringing blood to the heart
ventricular septal defects, holes in the walls that separate the left and right sides of the heart
patent ductus arteriosus (PDA), an abnormal connection between the aorta and the pulmonary artery that mixes oxygenated and unoxygenated blood
Other causes of congestive heart failure in children include:
rheumatic heart disease (RHD), caused by damage to the heart from group A strep infections
bacterial endocarditis, an inflammation of the lining of the heart due to an infection
myocarditis, inflammation of the heart muscle
complications of open heart surgery
chronic anemia, a low red blood cell count developing over a period of time
What can be done to prevent the condition?
Prompt treatment of the underlying disease can lower the child's risk of developing congestive heart failure. Maintaining a healthy body weight, including physical activity in everyday life, and eating a diet designed to minimize heart disease can help minimize congestive heart failure.
How is the condition diagnosed?
Congestive heart failure is diagnosed on the basis of the child's medical history and physical exam. Identification of the underlying disease may require special tests, including:
electrocardiogram (ECG), which graphs the electrical activity of the heart
chest X-ray (CXR), which may reveal an abnormally enlarged heart
echocardiography, which uses ultrasound waves to provide information about the structure, function, and motion of the heart
cardiac catheterization, which involves injection of a contrast agent to allow the doctor to watch the blood flow through the heart and its arteries
Long Term Effects
What are the long-term effects of the condition?
If untreated, congestive heart failure in children can lead to early death. Long-term effects may include delays in the child's development and permanent damage to organs such as the brain, liver, and kidneys.
What are the risks to others?
Congestive heart failure is not contagious and poses no risk to others.
What are the treatments for the condition?
Congestive heart failure in children can sometimes be diagnosed when the baby is still in the womb. If this is the case, the mother can be treated with diuretics (water pills) and other medications. This may help reduce the effect on the baby.
After the baby is born, general treatment measures will include giving oxygen, limiting sodium in the diet, and treating underlying anemia. A heart medication called digoxin (i.e., Lanoxin) can be used to help improve the efficiency of the heart. Diuretics help relieve some of the pressure on the heart by removing extra fluid.
In severe cases, stronger heart medications can be used to help the heart pump with more forceful contractions. Medications that relax the blood vessels can also be used. If the cause of CHF is congenital heart disease, open heart surgery may be needed.
What are the side effects of the treatments?
Heart medications used in the treatment of CHF can have serious side effects. Digoxin must be used carefully to avoid toxic effects. Water pills can cause excessive dehydration and salt imbalances. Surgery can be complicated by bleeding, infection, or a reaction to the anesthetic.
What happens after treatment for the condition?
Treatment of the underlying condition often eliminates the congestive heart failure. If a structural defect is the cause of the CHF, open heart surgery can restore normal blood flow in the body. However in some cases, long-term medical treatment is required.
Once the acute medical problem is resolved, a child with congestive heart failure should be encouraged to reduce coronary risk factors. This may include control of other diseases such as diabetes and high blood pressure, as well as eating a healthy diet for heart disease.
How is the condition monitored?
Monitoring varies, depending on the underlying cause of the congestive heart failure. Blood tests, such as a complete blood count (CBC), can track the treatment of anemia. Kidney and liver function tests help to detect any damage from medications used to treat CHF. Any new or worsening symptoms should be reported to the health care professional.
Merck Manual, 1999
Heart Disease: A Textbook of Cardiovascular Medicine, Braunwald E., 1980
Emergency Pediatrics: A Guide to Ambulatory Care, Barkin, R., 1990