When Your Child Has Congestive Heart Failure (CHF)

Congestive heart failure (CHF) is a condition in which the heart does not pump as well as it should. When this happens, fluid can build up in the lungs or body tissues (congestion). CHF can cause lung problems, organ failure, and other serious problems in the body. CHF can usually be treated, but it is important to find out the underlying cause. Your child’s healthcare provider will evaluate your child’s heart and discuss treatment options with you.

What causes congestive heart failure?

CHF often develops in children with certain heart defects present at birth (congenital heart defects). These include defects such as holes in the heart, which cause an increased amount of blood flow from one side of the heart to the other. This changes the dynamics of blood flow and can cause one side of the heart to become weaker. The heart then is unable to support the blood flow resulting in worsening heart function. CHF can also be caused by other types of heart problems such as cardiomyopathy, a condition in which the heart’s pumping function is impaired. Some non-heart problems, such as kidney failure, can lead to CHF due to changes in the body's fluid balance or hormone changes that lead to high blood pressure.

What are the symptoms of CHF?

Symptoms vary but may include:

• Swelling (edema) in the face, abdomen, ankles, or feet

• Shortness of breath, rapid breathing, wheezing, or excessive coughing

• Sweating

• Weakness or tiredness

• Poor feeding and weight gain (in infants)

• Racing heartbeat

• Wheezing

• Abdominal pain and nausea

In older children, symptoms may also include:

• Weight loss

• Passing out

• Chest pain

• Tiring easily during exercise

How is the cause of congestive heart failure diagnosed?

Heart problems in children are usually diagnosed and treated by a pediatric cardiologist. This is a doctor who specializes in diagnosing and treating children's heart disease. The cardiologist will do a physical exam and ask about your child’s health history. The following tests may be done to find the underlying cause of CHF:

• Chest X-ray. This test takes a picture of the heart and lungs. The picture can show your child’s heart size and shape. This picture also shows the fluid status of your child's lungs, which can be a clue to the heart's function.

• Electrocardiogram (ECG or EKG). During this test, the electrical activity of the heart is recorded to check for heart rhythm problems (arrhythmias) or problems with heart structure.

• Echocardiogram (echo). During this test, sound waves (ultrasound) are used to create a picture of the heart. This test can show problems with heart structure or function. This includes showing how well the heart pumps, if the heart is enlarged, the direction and strength of blood flow, or if there are any valve problems.

• Lab tests. For these tests, blood and urine samples are taken to check for problems in the kidneys or other organs.

How is congestive heart failure treated?

Specific treatment for your child depends on the cause of CHF. If the cause of CHF in your child is a congenital heart defect, a catheter or surgical procedure may be done to repair the defect.

• Medicines are often prescribed to help manage your child’s symptoms. These can include:

  • Diuretics help rid the body of excess water. This reduces fluid in the lungs and may improve breathing. These are very important in helping manage fluid status in heart failure.

  • Digoxin helps the heart pump blood with more force. This improves the heart’s performance.

  • ACE inhibitors make blood vessels relax and allow blood to flow more easily from the heart. 

  • Angiotensin receptor blockers or ARBs are very similar to ACE inhibitors. They may be used in a child who can't take an ACE inhibitor.

  • Beta-blockers lower blood pressure and slow heart rate by altering hormones that can damage the heart. Beta-blockers can also improve the heart’s pumping action over time.

• Pacemaker. Some children with heart failure need an artificial pacemaker. The pacemaker may help when the heart is not pumping well because of a slow heartbeat.

• Cardiac resynchronization therapy. This uses a special type of pacemaker that paces both pumping chambers of the heart at the same time to coordinate contractions and improve the heart's function. This treatment may be used in some children with long-term heart failure.

• Heart transplant. This is when the diseased heart is replaced with a healthy heart from a donor. This is only an option for very serious disease. And, it often takes some time to find a suitable heart. In some cases, a child may be able to be helped with devices that help the heart pump while he or she waits for a transplant.

Your child may benefit from seeing a nutritionist to help with nutrition for growth problems and to help balance fluids. He or she may also participate in an exercise rehab program to help with the ability to be active.

What are the long-term concerns?

The outcome for a child with CHF depends on many factors, including the underlying heart problem. The cardiologist will discuss your child’s condition, treatment options, and potential outcomes with you.