Heart Failure

What is heart failure?

Heart failure, also called congestive heart failure, is a condition in which the heart fails to pump enough blood for all of the body’s organs. The heart keeps pumping, but not as well as a healthy heart. Usually, when a heart cannot pump as much as it should, there is a problem with the heart.

What causes heart failure?

Heart failure can be caused by any or all of the following:

  • Heart valve disease caused by past rheumatic fever or other infections
  • High blood pressure (hypertension)
  • Active infections of the heart valves and/or heart muscle (for example, endocarditis or myocarditis)
  • Previous heart attack(s) (myocardial infarction). Scar tissue from prior damage may interfere with the heart muscle’s ability to pump normally.
  • Coronary artery disease, which is a narrowing of the arteries that supply blood to the heart muscle
  • Cardiomyopathy or another primary disease of the heart muscle. Learn more about cardiomyopathy.
  • Congenital heart disease or defects (present at birth)
  • Cardiac arrhythmias (irregular heartbeats)
  • Chronic lung disease and pulmonary embolism
  • Certain medications
  • Excessive sodium (salt) intake
  • Anemia and excessive blood loss
  • Complications of diabetes.

How does heart failure affect the body?

Heart failure interferes with the kidney’s normal function of eliminating extra sodium and waste products from the body. In congestive heart failure, the body retains more fluid, resulting in swelling of the ankles and legs. Fluid also collects in the lungs, which can cause shortness of breath.

What are the symptoms of heart failure?

The following are the most common symptoms of heart failure. However, each individual may experience symptoms differently. Symptoms may include:

  • Shortness of breath during rest, exercise or while lying flat
  • Problems keeping up with other children of the same age, or stopping to rest while playing
  • Trouble eating (for babies)
  • Fast breathing or pulling in between the ribs (retractions)
  • Poor appetite
  • Weight gain
  • Visible swelling of the face, legs and ankles (due to a buildup of fluid), and, occasionally, swelling of the abdomen
  • Fatigue and weakness
  • Loss of appetite, nausea and abdominal pain
  • Persistent cough that can cause blood-tinged sputum.

The severity of the condition and symptoms depends on how much of the heart’s pumping capacity has been compromised.

The symptoms of heart failure may resemble other conditions or medical problems. Always consult your child’s health care provider for a diagnosis.

How is heart failure diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for heart failure may include any, or a combination of, the following:

  • Chest X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. Learn more about X-ray.
  • Echocardiogram (also called echo). A noninvasive test that uses sound waves to evaluate the motion of the heart’s chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. Learn more about echocardiogram.
  • Electrocardiogram (ECG or EKG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage. Learn more about electrocardiogram.
  • BNP testing. B-type natriuretic peptide (BNP) is a hormone released from the ventricles in response to increased wall tension (stress) that occurs with heart failure. BNP levels rise as wall stress increases. BNP levels are useful in the rapid evaluation of heart failure. In general, the higher the BNP levels, the worse the heart failure. Learn more about blood tests used to diagnose heart problems.

How is heart failure treated?

Specific treatment for heart failure is determined by each patient’s health care team based on:

  • The child’s age, overall health and medical history
  • The extent and cause of the heart failure
  • The child’s tolerance for specific medications, procedures or therapies
  • Expectations for the course of the heart failure
  • The family’s opinion or preference.

The goal of treatment is to improve the child’s quality of life by making the appropriate lifestyle changes and implementing drug therapy.

Treatment of heart failure at CHOC may include:

Controlling risk factors:

  • Losing weight (if overweight)
  • Restricting salt and fat from the diet
  • Proper rest
  • Controlling blood sugar if diabetic
  • Controlling blood pressure
  • Limiting fluids.

Medication, such as:

  • Angiotensin converting enzyme (ACE) inhibitors. This medication decreases the pressure inside the blood vessels and reduces the resistance against which the heart pumps.
  • Angiotensin receptor blockers (ARB). This is alternative medication for reducing workload on the heart if ACE inhibitors are not tolerated.
  • Diuretics. These reduce the amount of fluid in the body.
  • Vasodilators. These dilate the blood vessels and reduce workload on the heart.
  • Digitalis. This medication helps the heart beat stronger with a more regular rhythm.
  • Inotropes. These increase the pumping action of the heart muscle.
  • Antiarrhythmia medications. These help maintain normal heart rhythm and help prevent sudden cardiac death.
  • Beta-blockers. These reduce the heart’s tendency to beat faster and reduce workload by blocking specific receptors on heart cells.
  • Aldosterone blockers. Medication that blocks the effects of the hormone aldosterone which causes sodium and water retention.

Biventricular pacing/cardiac resynchronization therapy: A new type of pacemaker that paces both pumping chambers of the heart simultaneously to coordinate contractions and to improve the heart’s function. Some heart failure patients are candidates for this therapy. Learn more about pacemakers.

Implantable cardioverter defibrillator: A device similar to a pacemaker that senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm. Learn more about defibrillators.

Heart surgery: If heart failure is due to a congenital heart defect, heart valve problem, or sometimes other problems, heart surgery may be needed. The child’s cardiologist will discuss all treatment options available to the child. Learn more about heart surgery at CHOC.