Signs of heart failure in a child: Symptoms and treatment

Heart failure is when the heart cannot properly pump blood around the body. Children with heart failure may experience shortness of breath, fatigue, swelling in their legs, ankles, and feet, and skin discoloration.

According to the Centers for Disease Control and Prevention (CDC), about 1% of newborn infants in the United States have a form of heart abnormality that can cause heart failure.

This article explores the signs and symptoms of heart failure in children. It also discusses causes, diagnosis, and treatment and how a person can spot the signs and manage heart failure in children.

The signs and symptoms of heart failure can vary among children of different age groups.

Infants and younger children can experience the following symptoms:

In older children and adolescents, symptoms may include:

A person should monitor their child at home so that they can identify problems early. Rapid weight gain may indicate a child is retaining excess fluid. Caregivers should regularly weigh the child to stay aware of any sudden weight changes.

A person should contact a doctor if the child experiences worsening symptoms, including:

  • trouble breathing
  • swelling
  • fatigue
  • loss of appetite
  • excessive sweating
  • chest pain

Heart failure can be more challenging to diagnose in newborns than in older children because symptoms are usually nonspecific, may resemble pulmonary infections, and require a high index of clinical suspicion.

To diagnose heart failure in a child, a doctor will take a medical history and conduct a physical examination. They will also ask questions about their appetite, breathing patterns, and energy levels.

Additionally, they can order diagnostic tests, such as:

  • Blood tests: They can detect heart strain or any underlying cause using biomarkers of heart failure.
  • X-ray: An X-ray can identify an enlarged heart, lung congestion, extra blood flow, as well as the progression of the condition.
  • EKG: An EKG can indicate an atypical heart rhythm.
  • Echocardiogram: This is an ultrasound scan that helps doctors evaluate the structure and function of the heart.
  • Exercise stress test: The doctor may order an exercise stress test to evaluate heart-lung function in children older than 4 years. The doctor will take an electrocardiogram while the child exercises on a treadmill.
  • Cardiac catheterization: This test requires a short hospital stay and a general anesthetic. The doctor will insert a small plastic tube, called a catheter, into the child’s heart through a blood vessel in the leg or arm. This catheter will record the pressure and oxygen levels in the different sections of the heart. They will often inject a contrast dye to make the heart and coronary arteries easier to see. This can also make it possible to record images or video to help assess the heart’s function.

To treat heart failure, doctors will consider several factors, including:

  • the cause of the condition
  • the severity of symptoms
  • the child’s age, health status, and medical history
  • the progression of the disease
  • the child’s ability to tolerate specific medications, procedures, or therapies
  • parent or caregiver’s preferences

Following a heart failure diagnosis, a cardiologist will evaluate a child’s situation, present treatment options, and determine the best treatment plan. Treatment aims to eliminate the cause, relieve symptoms, and delay the progression of the disease.

Treatments may include lifestyle changes, medication, and surgery, which appear in more detail below.

Lifestyle changes

Research recommends infants take in enough calories to ensure they are consuming sufficient nutrients to grow. This research also states that infants may tolerate smaller, more frequent meals better than larger ones.

Doctors may recommend that a child takes dietary supplements that compensate for the extra calories. Doctors may also recommend the child follows a diet low in salt and fat and reduce fluid intake if they have swelling that does not respond to diuretic medication.

These changes may reduce a child’s symptoms, but they will not cure the underlying cause of heart failure.

It is essential that a person follows the dietary plan that the doctor suggests.

Medications

According to a 2021 study, doctors can prescribe the following medications to treat pediatric heart failure:

  • Diuretics: This is usually the first line of treatment for heart failure in children. Diuretics help remove excess fluids in the body. Furosemide is one example of a diuretic medication that healthcare professionals recommend for pediatric heart failure.
  • Inotropes: This type of medication changes the strength of the heart’s contractions. Positive inotropes increase the force of contractions, while negative inotropes decrease it. Inotropes can include digoxin, dopamine, and dobutamine. However, a 2016 study notes a lack of data from pediatric studies showing that inotropes are beneficial to those with acute heart failure.
  • Beta-blockers: This class of medication reduces heart rate and blood pressure so that the heart can pump blood more efficiently. However, according to the authors of the 2016 study, doctors do not fully understand the benefits of beta-blockers in children. Carvedilol is the most widely studied beta-blocker for pediatric heart failure.
  • Angiotensin-converting enzyme (ACE) inhibitors: This medication dilates the blood vessels and lowers the blood pressure so the heart can pump blood around the body more easily. ACE inhibitors can improve symptoms, slow the progression of heart failure, and improve survival rates in adults. Some smaller studies show ACE inhibitors contribute to improved survival rates in children.

Surgery

If a child’s symptoms do not significantly improve after taking medications, the doctor may recommend the following surgical procedures.

  • Pacemaker: Doctors may recommend a small implantable medical device called a pacemaker to correct a slow or irregular heartbeat.
  • Cardiac ablation: A doctor may perform a radiofrequency ablation for children with a rapid heartbeat. During this procedure, radio waves will cause scarring of small areas of heart tissue to block electrical signals causing an irregular heartbeat.
  • Heart transplant: Children with end stage heart failure may have a heart transplant when all other treatment options have been ineffective. The child will receive a healthy heart from a donor.

There are various causes of pediatric heart failure. These may include:

Congenital heart defects

The most common cause of heart failure in children is a congenital heart defect. Congenital means the abnormality has been there since birth. According to an older 2010 study, approximately 8 in 1,000 newborn babies will be born with a heart defect.

A congenital heart abnormality occurs when the heart fails to develop correctly in the womb. Doctors can detect a heart abnormality before a child is born, and signs and symptoms may present soon after delivery or during the first few months of the child’s life.

The types of congenital heart abnormalities can include:

  • Ventricular septal defect: A hole in the wall dividing the two lower chambers of the heart can cause oxygenated blood to mix with deoxygenated blood. This can lead to increased pressure in the heart and low oxygen levels throughout the body. Usually, this wall closes before birth.
  • Atrial septal defect: In this abnormality, there is a hole in the wall that divides the two upper chambers of the heart. This can also allow oxygenated blood to mix with deoxygenated blood. It causes the heart and lungs to work harder and can damage the arteries in the lungs.
  • Ebstein’s anomaly: This is a heart abnormality where a valve in the heart does not close properly, causing blood to leak back from the lower right chamber to the upper right chambers in the heart.
  • Coronary artery issues: In some cases, problems with the coronary arteries can stop blood from flowing effectively to the heart. Doctors call this a pump failure. While a child can be born with a pump failure, infections can also cause them.
  • Tetralogy of Fallot: This is a serious heart condition that causes four structural problems in the heart. In infants and young children, this can cause cyanosis, where light skin turns blue or darker skin can appear gray due to circulation issues or insufficient blood oxygenation. These four structural problems include:
    • a hole between the lower chambers of the heart
    • a thickened muscle surrounding the lower right chamber of the heart
    • obstructions stopping blood from being pumped from the heart to the lungs
    • the aorta lying over the hole in the lower heart chambers

Primary cardiomyopathies

Primary cardiomyopathies are a group of conditions that can affect the structures and functions of the cardiac muscles. A weak heart muscle cannot pump sufficient blood to the organs and tissues in the body.

Inherited genetic mutations, viral infections, autoimmune diseases, or metabolic deficiencies can cause primary cardiomyopathy.

Examples of primary cardiomyopathies are:

  • Arrhythmogenic right ventricular dysplasia: This is a rare form of nonischemic cardiomyopathy. Here, fatty tissue replaces the muscle comprising the right ventricle of the heart. Children may experience symptoms, but many people do not develop symptoms until between the ages of 30 and 40 years.
  • Dilated cardiomyopathy: This refers to the enlargement of the left or right ventricle due to the heart pumping too weakly.
  • Hypertrophic cardiomyopathy: This condition involves the thickening of the walls of the heart, which can restrict blood flow in and out of the heart.
  • Restrictive cardiomyopathy: Here, the walls of the heart become stiff, which restricts blood flow into this organ. However, this is very rare in children.

Other causes

Other causes of heart failure in children can include:

  • toxins
  • ischemia, or decreased blood flow and oxygen to the heart
  • viral infections
  • electrolyte imbalances
  • abnormal drug interactions

There is a lack of scientific literature about the complications of childhood heart failure. However, 2016 research states that outcomes are better in children than in adults, as heart failure in these younger individuals is often due to reversible problems.

Possible complications of childhood heart failure include:

How a child lives with pediatric heart failure will depend on the type of heart failure they have, how serious their condition is, and their age. A child with heart failure needs regular checkups and an exercise plan. They may also have a treatment plan that includes dietary supplements and medicines.

To support a child with heart failure, caregivers should:

  • attend regular medical appointments with the child
  • provide a balanced diet with fruits and vegetables
  • limit salt and fat intake
  • monitor their fluid intake
  • administer recommended medications and nutritional supplements
  • support the child with exercise

Heart failure in children can occur due to congenital conditions, weakness in the heart muscles, or other causes. The signs and symptoms can vary significantly among children of different age groups.

A doctor may recommend a combination of lifestyle modifications, drug therapy, or surgery to treat pediatric heart failure, depending on the type and severity of the child’s condition. However, more research is necessary into some drug therapies, as many studies focus on adults.

With advances in medical research, early diagnosis, and treatment, children with heart failure can live active and fulfilling lives.

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