What Causes Heart Failure in Children?

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Overcirculation Failure: About 1 percent of all newborn infants will have some type of structural heart defect. In some of these defects, there are holes between the right and left chambers inside the heart. Because of these holes, the blue and red bloods mix inside the heart. A defect of blood vessels in the head or other parts of the body (AV malformation) can cause similar mixing of the blue and red blood but outside the heart. Abnormal heart valves can also cause heart failure. An abnormally formed valve that does not close properly causes blood to leak backwards. Rarely, a Strep throat infection can result in damage to otherwise normal heart valves, causing them to leak as well. Finally, low blood (anemia) can also result in heart failure. These defects lead to overcirculation failure. In each instance, an overload blood flow pattern occurs in one or more of the sections of the heart. The normal forward blood flow is interrupted and the heart becomes an inefficient pump.

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Pump Failure: As in the adult, a child’s heart may develop pump failure. This can be caused by a virus infection that damages otherwise normal heart muscle or from problems with the coronary arteries that occur from birth or are the result of infection and prevent effective blood flow to the heart muscle itself. Older children and teenagers may complain of becoming tired quickly, especially if a virus infection has caused heart muscle damage. Certain drugs, some necessary to treat other medical problems (like cancer or leukemia) can also damage the heart muscle. The heart’s electrical system also may be abnormal from birth or damaged by infection, causing the heart to beat too slow or too fast. Sometimes one of the heart valves does not open properly causing pressure to back up inside the heart chambers. Rarely, severe chest trauma may damage the heart. Children with muscular dystrophy may eventually also develop problems with their heart muscle. In all of these situations, the heart muscle fails to function normally and the heart becomes an inefficient pump.

How Is Heart Failure Identified?

In infants, heart failure often presents with breathing trouble, poor feeding, poor growth, excessive sweating or even low blood pressure. At times, heart failure can look like other problems such as colic, pneumonia, or other respiratory infections. Often parents may note that an infant takes longer to feed or becomes uninterested in feeding after a short time. If heart failure is caused by too rapid a heartbeat, parents may feel the rapid heartbeat through the chest wall when the infant is sleeping or resting quietly.

If your physician suspects that your child may be experiencing symptoms of heart failure, a chest x-ray may help to determine if the heart is enlarged. You also may be referred to a pediatric heart specialist (pediatric or congenital heart cardiologist) for further evaluation and testing. Additional tests can include an electrocardiogram (EKG) (more on EKG's) to evaluate the heart rhythm or an ultrasound of the heart (echocardiogram) [more on echocardiograms] to evaluate heart structure and function. Both of these tests are simple, typically performed in the physician’s office or clinic and are not painful for the child. However, depending on the child’s age and ability to cooperate, light sedation may be necessary to obtain the best test results.

Sometimes, older children (usually over age 4) may be asked to perform an exercise stress test to evaluate heart-lung function. At times a more detailed and invasive test, called a heart catheterization study, may be required. In this test, a small plastic tube (catheter) is placed inside the heart from a blood vessel in the leg or arm to record pressures and the amount of oxygen in the different parts of the heart. Commonly a small amount of an x-ray dye (contrast) material is injected to make a movie of the heart function and coronary arteries. The child usually receives deep sedation to ensure the best test results. Since this test is performed in a special catheterization procedure room or laboratory, a short admission to a hospital is often necessary.

How Is Heart Failure Treated?

If heart failure is caused by overcirculation due to a congenital heart defect, surgery is often necessary to repair the defect. Often your physician may initially treat your child with medications to help unload the excessive volume, lower blood pressure resistance and allow the heart’s pump function to improve. At times your child may need to be hospitalized to begin this treatment. These medications may include diuretics (water pills) and afterload reducers. Since overcirculation causes poor growth, your physician may consider nutritional supplements to ensure that your child is receiving enough calories to compensate for the increased energy requirements. Other dietary changes such as low salt and low fat diets may be discussed. Following appropriate treatment, your child’s condition and symptoms may improve. This is called compensated heart failure. However, the underlying cause may persist. If heart surgery is required, you will have the opportunity to discuss the types of surgery or other treatments available.

If the heart failure is caused by pump failure, the same medications listed above may be used. Sometimes other medications that lower blood pressure help the heart pump better. Hospitalization may be necessary to further improve heart function. At times, surgery may also be required, such as replacing a damaged heart valve.

Pump failure caused by too slow a heartbeat often requires a pacemaker (more on pacemakers). These small battery-operated devices are like tiny computers and are implanted under your child’s skin with a small wire connected to the heart. This requiresa surgical procedure. Pacemakers remind the heart to maintain a normal heart rate. If the pump failure is caused by the heart beating too fast, your child may require medications to control the heartbeat. At other times, a specialized heart catheterization procedure called radiofequency ablation may be recommended to correct the abnormal heart rhythm by applying short bursts of radio waves to the area of heart muscle causing the rapid heart beat.

Rarely, if pump failure is caused by irreversible muscle damage, heart function may not improve with medication but may continue to get worse. In this situation, a special pacemaker, mechanical pump (LVAD) or ECMO (extracorporeal membrane oxygenator) may be necessary to temporarily improve heart pump function. If heart muscle function continues to deteriorate despite therapy, your heart specialist may discuss the need for a heart transplant.

Conclusion

Heart failure can happen to all children. However, it is not necessarily a hopeless condition. Many of the causes can be repaired. It's important that parents and family members understand the causes and treatments of heart failure in children and to ensure that proper medical care is provided. As newer techniques and medications become available, most children with heart failure should be able to grow and lead active lives.

 

o more than 10 months.

 About Heart Failure

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Updated:Sep 20,2012

The term "heart failure" makes it sound like the heart is no longer working at all and there's nothing that can be done. Actually, heart failure means that the heart isn't pumping as well as it should be.

Your body depends on the heart's pumping action to deliver oxygen- and nutrient-rich blood to the body's cells. When the cells are nourished properly, the body can function normally.

With heart failure, the weakened heart can't supply the cells with enough blood (View an animation of heart failure) . This results in fatigue and shortness of breath. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.

Heart failure is a serious condition, and usually there's no cure. But many people with heart failure lead a full, enjoyable life when the condition is managed with heart failure medications and healthy lifestyle changes. It's also helpful to have the support of family and friends who understand your condition.

How the normal heart works

The normal healthy heart is a strong, muscular pump a little larger than a fist. It pumps blood continuously through the circulatory system.

The heart has four chambers, two on the right and two on the left:

•Two upper chambers called atria (one is an atrium)

•Two lower chambers called ventricles

Oxygen-rich blood travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the rest of the body.

The right atria takes in oxygen-depleted blood from the rest of the body and sends it back out to the lungs through the right ventricle.

The heart pumps blood to the lungs and to all the body's tissues by a sequence of highly organized contractions of the four chambers. For the heart to function properly, the four chambers must beat in an organized way.

What is heart failure?

Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through to meet the body's needs for blood and oxygen. Basically, the heart can't keep up with its workload.

At first the heart tries to make up for this by:

•Enlarging. When the heart chamber enlarges, it stretches more and can contract more strongly, so it pumps more blood.

•Developing more muscle mass. The increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly, at least initially.

•Pumping faster. This helps to increase the heart's output.

The body also tries to compensate in other ways:

•The blood vessels narrow to keep blood pressure up, trying to make up for the heart's loss of power.

•The body diverts blood away from less important tissues and organs to maintain flow to the most vital organs, the heart and brain.

These temporary measures mask the problem of heart failure, but they don't solve it. Heart failure continues and worsens until these substitute processes no longer work.

Eventually the heart and body just can't keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a trip to the doctor.

The body's compensation mechanisms help explain why some people may not become aware of their condition until years after their heart begins its decline. (It's also a good reason to have a regular checkup with your doctor.)

Heart failure can involve the heart's left side, right side or both sides. However, it usually affects the left side first.

 Understanding Blood Pressure Readings

 

Blood pressure is typically recorded as two numbers, written as a ratio like this:

Systolic

The top number, which is also the higher of the two numbers, measures the pressure in the arteries when the heart beats (when the heart muscle contracts).

 

Diastolic

The bottom number, which is also the lower of the two numbers, measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood).

 

* Your doctor should evaluate unusually low blood pressure readings.

How is high blood pressure diagnosed?

Your healthcare providers will want to get an accurate picture of your blood pressure and chart what happens over time. Starting at age 20, the American Heart Association recommends a blood pressure screening at your regular healthcare visit or once every 2 years, if your blood pressure is less than 120/80 mm Hg.

Your blood pressure rises with each heartbeat and falls when your heart relaxes between beats. While BP can change from minute to minute with changes in posture, exercise, stress or sleep, it should normally be less than 120/80 mm Hg (less than 120 systolic AND less than 80 diastolic) for an adult age 20 or over.About one in three (33.5%) U.S. adults has high blood pressure.

 

If your blood pressure reading is higher than normal, your doctor may take several readings over time and/or have you monitor your blood pressure at home before diagnosing you with high blood pressure.

A single high reading does not necessarily mean that you have high blood pressure. However, if readings stay at 140/90 mm Hg or above (systolic 140 or above OR diastolic 90 or above) over time, your doctor will likely want you to begin a treatment program. Such a program almost always includes lifestyle changes and often prescription medication for those with readings of 140/90 or higher.

If, while monitoring your blood pressure, you get a systolic reading of 180 mm Hg or higher OR a diastolic reading of 110 mm HG or higher, wait a couple of minutes and take it again. If the reading is still at or above that level, you should seek immediate emergency medical treatment for a hypertensive crisis. If you can't access the emergency medical services (EMS), have someone drive you to the hospital right away.

Even if your blood pressure is normal, you should consider making lifestyle modifications to prevent the development of HBP and improve your heart health.

Which number is more important, top (systolic) or bottom (diastolic)?

Typically more attention is given to the top number (the systolic blood pressure) as a major risk factor for cardiovascular disease for people over 50 years old. In most people, systolic blood pressure rises steadily with age due to increasing stiffness of large arteries, long-term build-up of plaque, and increased incidence of cardiac and vascular disease.

Heart Valve Surgery is meant to restore the function of your heart valves, which may be diseased or damaged. Several valves can be repaired surgically and not require a valve replacement. A replacement valve may be taken from another human heart, an animal, or it can be a mechanical one. This is more commonly used to repair leaky mitral valves and tricuspid valves. It can also be helpful for repairing prolapse of the mitral valve

Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your heart's blood vessels using special X-rays called angiograms. Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter

A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty. The stent stays in the artery permanently. The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina).

 

 

 

Angina

Angina is chest pain or discomfort that occurs when your heart doesn't get as much blood and oxygen as it needs. Over time, the coronary arteries that supply blood to your heart can become clogged with plaque. If one or more arteries are partly clogged, not enough blood can flow through, and you can feel chest pain or discomfort. Reversible (stable) angina occurs when the heart works harder and needs more oxygen, and goes away when heart demand is decreased. Progressive (unstable) angina occurs when a plaque in one or more of your coronary arteries ruptures (bursts). If the buildup happens rapidly, you are at risk for a heart attack.

 

 

 

 

Peripheral Artery Disease

Peripheral Artery Disease (PAD) is a narrowing of the peripheral arteries, most commonly in the arteries of the pelvis and legs. A buildup of fatty deposits (plaque) narrows or blocks your arteries. The iliac, femoral, popliteal and tibial arteries are commonly affected.

Pacemaker

A pacemaker is a small battery-operated device that helps your heart beat in a regular rhythm. It does this with a small electric stimulation that helps your heart to beat regularly. Your doctor puts the pacemaker under the skin on your chest, just under your collarbone. It’s hooked up to your heart with tiny wires.

Cardiac Resynchronization Therapy

 

Some people with heart failure develop abnormal heartbeats, or arrhythmias. Some arrhythmias may reduce how well the heart's lower chambers (ventricles) function. Cardiac Resynchronization Therapy (CRT), also known as biventricular pacing, may be needed. In this procedure, a special pacemaker is used to make the ventricles contract at the same time. This helps the lower heart chambers pump and relax together.

 

Implantable Cardioverter Defibrillator


An Implantable Cardioverter Defibrillator (ICD) is a battery-powered device placed under your skin, beneath the collarbone, that monitors your heart rate. It uses batteries to send electric signals to a heart that's beating too slow, same as a pacemaker. It can also deliver an electric shock to help restore a normal heartbeat to a heart that's beating chaotically and much too fast.

 

Coronary Arteries

 

The Coronary Arteries are the blood vessels that supply blood to your heart. They branch off of the aorta at its base. The right coronary artery, the left main coronary, the left anterior descending, and the left circumflex artery, are the four major coronary arteries. Blockage of these arteries is a common cause of angina, heart disease, heart attacks and heart failure.


 

Hemorrhagic Stroke

Heart Failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through the heart to meet the body's needs for blood and oxygen. Heart failure usually results in an enlarged heart