Overview, Causes, & Risk Factors
Congestive heart failure 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. It then
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, or
holes in the walls that separate the left and right sides of the heart
patent ductus arteriosus, or 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, caused by damage to the heart from group A strep infections
bacterial endocarditis, or
inflammation of the lining of the heart due to an infection
myocarditis, or inflammation of
the heart muscle
complications of open heart
chronic anemia, which results
in a low
red blood cell count
Symptoms & Signs
What are the signs and symptoms of the condition?
Most of the time, congestive heart failure occurs quickly in children. Failure
of both ventricles is common. This causes a combination of symptoms, including:
shortness of breath
a rapid heartbeat
coughing and wheezing
failure to thrive,
meaning that the child's growth and weight gain are slower than expected
loss of appetite
swelling of the hands and feet
pain and tenderness of the abdomen
coolness of extremities to the touch
grayish tint to the skin
Diagnosis & Tests
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, or ECG,
which graphs the electrical activity of the heart
chest X-ray, 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
Prevention & Expectations
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.
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.
Treatment & Monitoring
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
medications and water pills. This may help lessen 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
digitalis can be used to help improve the efficiency of the heart. Water pills
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 done.
What are the side effects of the treatments?
Heart medications used in the treatment of CHF can have serious side effects.
Digitalis must be used carefully to avoid toxic effects. Water pills can cause
excessive dehydration and
salt imbalances. Surgery can cause
bleeding, infection, and allergic
reactions to anesthesia.
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 CBC
or complete blood count, can track the treatment of anemia. Kidney function tests 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 provider.