Congestive Heart Failure

Congestive heart failure occurs when the heart cannot pump blood as well as it should and is unable to meet the body’s needs. It can affect people of all ages, but in children, it may be caused by a congenital defect.

About Congestive Heart Failure

One or both sides of the heart can be impacted by congestive heart failure. If function is affected in the right side of the heart, blood cannot be effectively forced into the lungs’ vessels and blood can back up in the veins as the heart becomes congested. The lower legs, feet, ankles, abdomen, and eyelids may swell as fluid is retained. If the left side of the heart fails, blood cannot be pumped efficiently into the body and may back up in the lungs, stressing the lungs and causing fast, difficult breathing. As a result, the body does not receive adequate oxygenated blood and children may feel fatigued or not grow properly.

For some children, congestive heart failure may be caused by heart defects they were born with, such as aortic stenosis, atrioventricular canal defect, or atrial septal defect. These defects can alter how blood flows through the heart and push a higher volume of blood through one side, causing the heart to weaken and fail to pump adequate blood to the body. Conditions that affect how the heart pumps blood, such as hypertrophic cardiomyopathy, dilated cardiomyopathy, and cardiac arrhythmia, can also cause congestive heart failure. Other medical conditions, including an overactive thyroid, high blood pressure, a viral infection, chronic lung disease, heart valve disease, and other heart defects, can cause congestive heart failure.

Without treatment, a child who suffers from congestive heart failure may experience lung problems, organ failure, or other serious conditions. Effective treatments for congestive heart failure are available; however, the underlying cause should also be identified and treated to best protect your child’s life.

Symptoms of Congestive Heart Failure

Congestive heart failure symptoms may resemble other conditions. Speak with your child’s doctor or make an appointment with a pediatric cardiologist for a diagnosis.

Symptoms of congestive heart failure may include:

• Cough and lung congestion
• Failure to gain weight
• Falling asleep when eating or seeming too tired to eat
• Lack of appetite
• Nausea
• Racing heartbeat
• Shortness of breath or abnormally fast breathing
• Sweating
• Swelling in the face, abdomen, ankles, or feet
• Weakness or tiredness
• Wheezing

Older children may also lose weight, faint, feel chest pain, or tire easily during exercise.

Diagnosing Congestive Heart Failure

A pediatric cardiologist may start by taking a full medical history, conducting a physical examination and asking questions about possible symptoms, such as your child’s eating, breathing, and activity level. There are several different tests your child’s cardiologist can use to help diagnosis congestive heart failure.

Tests performed when diagnosing congestive heart failure may include:

• Cardiac Catheterization: During cardiac catheterization, a small catheter (thin tube) is inserted into a larger blood vessel, typically in the groin, and guided to the heart where blood pressure and oxygen measurements can be taken in the aorta and pulmonary artery as well as the four chambers of the heart. A dye can also be injected through the tube to make the heart’s structure more visible on an X-ray. A biopsy can also be taken during this procedure to help figure out what caused the congestive heart failure.
• Chest X-Ray: A chest X-ray produces an image of the tissue and bones in the heart and lungs and helps your provider assess the shape, size, and structure of the heart and lungs as well as the aeration of or any congestion in the lungs.
• Echocardiogram: An echocardiogram uses ultrasound technology to create a moving image of the heart and its valves, allowing your provider to assess the structure and function of the heart. An echocardiogram also helps provide information about blood flow and how well the heart is pumping blood.
• Electrocardiogram (ECG or EKG): An electrocardiogram uses electrodes that are placed on the body to record the electrical activity taking place in the heart. An ECG/EKG test helps detect abnormal rhythms, such as cardiac arrhythmias, stress on the heart, and damage to the heart muscles.
• Lab Tests: Blood and urine tests can be used to evaluate how the kidneys and other organs are working as well as identify elevated platelet levels and high numbers of white blood cells.

Treating Congestive Heart Failure

Treatment plans for congestive heart failure can vary based on your child’s age, health, and medical history as well as the level of congestive heart failure and the prognosis.

Treatment options for congestive heart failure may include the following medicines:

• ACE (Angiotensin-Converting Enzyme) Inhibitors: Helps dilate or relax blood vessels so blood flows easier from the heart.
• Beta Blockers: Lowers blood pressure and slows your child’s heart rate for more efficient pumping.
• Digoxin: Helps the heart pump blood more forcefully.
  
• Diuretics: Helps the kidneys flush excess fluid and relieve fluid buildup in the lungs.

More invasive treatments for severe congestive heart failure may include implanting a pacemaker to treat an abnormal heartbeat or coordinate contractions, implanting a device to help the heart pump blood, or transplanting a new heart from a donor.

Because the severity of congestive heart failure can vary, your pediatric cardiologist can provide the best information about your child’s outcome after treatment. Children who take medication or require surgery may be able to resume their normal activities after recovering from the effects of congestive heart failure. Regardless of the type of treatment, your pediatric cardiologist may recommend ongoing care to monitor your child’s health.

Care Team Approach

The Texas Center for Pediatric and Congenital Heart Disease, a clinical partnership between Dell Children’s Medical Center and UT Health Austin, takes a multidisciplinary approach to your child’s care. This means your child and your family will benefit from the expertise of multiple specialists across a variety of disciplines. Your care team will include pediatric cardiologists, cardiothoracic surgeons, interventional cardiologists, critical care specialists, hospitalists, anesthesiologists, perfusionists, nurses, advanced practice providers, social workers, psychologists, child life specialists, dietitians, physical and occupational therapists, pharmacists, and more, who work together to provide unparalleled care for patients every step of the way. We collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to identify new therapies to improve treatment outcomes. We are committed to communicating and coordinating your child’s care with referring physicians and other partners in the community to ensure that we are providing comprehensive, whole-person care.

Learn More About Your Care Team