Heart Failure in Children: Symptoms, Causes, and Treatments

Heart failure is the failure of the heart to function properly. It involves serious health risks, so the early detection of heart failure in children is key to improving prognosis in the future.

The heart is one of the main organs of the body and its mission is to ensure blood flow to all cells and tissues. When this cardiac pump doesn’t function properly, the health of the whole body begins to deteriorate. For this reason, it’s important to be aware of and detect early warning signs of heart failure in children.

Thanks to its contractile properties, it pumps rhythmically, propelling the blood contained in the arteries so that it can reach every corner of the body. Together with the blood vessels (veins and arteries), it constitutes the circulatory system.

It’s a closed circuit through which blood will travel from the heart to the tissues (transporting oxygen and nutrients essential for life) and from the tissues to the heart (transporting cellular waste products, such as carbon dioxide).

What is heart failure in children?

When we say heart failure (HF), we’re talking about the set of signs and symptoms that result from the malfunction of the heart pump.

In children, this can be due to two main mechanisms: problems in filling the pump (diastolic dysfunction) or problems in blood ejection (systolic dysfunction). As a consequence of either of these, the end result will be inadequate blood flow to the tissues, unable to meet the minimum energy requirements.

What are the causes?

In the pediatric age group, the causes differ from those of adults. The main cause of heart failure in children is congenital malformations, that is, those conditions with which the child’s born. These are called congenital heart defects (CHD) and, according to estimates, eight out of every 1,000 children born alive will have them.

In addition to structural causes such as CHD, there are other causes of HF whose frequency of occurrence will depend on the age of the patient and certain environmental conditions. Some of them are the following:

• Infectious: infections acquired during pregnancy, associated with catheters, complications of streptococcal pharyngitis.
• Inflammatory: a consequence of autoimmune processes such as Lupus.
• Toxic: adverse effects of drugs, for example, chemotherapy.
• Metabolic: inborn errors of metabolism, such as those that the heel prick test seeks to detect.
• Arrhythmogenic: those that cause alterations in the heart’s pumping rhythm or arrhythmias.
• Post-surgical: those resulting from previous cardiac surgeries.
• Idiopathic: in these cases, we’re referring to undetermined causes, such as Kawasaki disease.

Symptoms and warning signs

A heart that doesn’t function properly will result in organs that aren’t properly oxygenated, as less blood will reach them or at a slower rate than necessary. As a general consequence, the body will show intolerance to effort and, in advanced cases, the same will occur during a resting state.

When heart failure begins early in life, the diagnosis isn’t simple, as its manifestations are very similar to those of other health conditions.

In the face of moderate efforts such as feeding, the baby will be irritable, sweaty, agitated, with weak crying and in some cases, there will be pallor or bluish coloration of the face (cyanosis). These breastfeeding difficulties will translate into poor weight gain and growth retardation.

At older ages, the child or adolescent will show signs of fatigue or intolerance to physical exertion. For example, after sports activity or in the context of situations of metabolic stress, such as an infection. Symptoms may include the following:

• The feeling of shortness of breath (dyspnea)
• Sweating and pallor
• Palpitations due to increased heart rate
• Dizziness or fainting due to decreased blood pressure
• Swelling in legs, feet, and face due to fluid retention or edema
• Abdominal pain or heaviness due to an accumulation of blood inside the viscera, such as the liver or spleen

When all these symptoms also appear during rest, doctors classify HF as severe and the prognosis becomes more ominous.

Diagnosing heart failure in children?

There’s no single test that can tell us the diagnosis with certainty. Still, for experienced eyes, the clinical manifestations of heart failure in children can be very informative.

In the presence of a baby with feeding difficulties, poor weight gain, changes in skin color, and excessive sweating during breastfeeding, it’s important to think about this cause and evaluate it correctly in order to detect or rule it out. When detected in the early stages, HF has a better prognosis than when it occurs in advanced stages or severe diseases.

If your pediatrician suspects this diagnosis, it’s important to consult a pediatric cardiologist to evaluate the best option for complementary studies. The options are variable, but, in general, one can opt for very minimally invasive studies such as the following:

• Chest X-ray
• Electrocardiogram
• Echocardiogram with Doppler
• Stress test (only in older children and adolescents)

Treatments for heart failure in children

The main objective of heart failure treatment is to minimize complications and slow the progression of cardiac deterioration. Doctors will choose the therapeutic option depending on the stage of the process.

In asymptomatic and mild cases, the most appropriate option will be oral medication. The most commonly used medications are the following:

• Diuretics: increase the elimination of body water through urine and improve edema.
• Beta-blockers: improve heart and respiratory rates, decrease overall symptoms, and help improve the child’s physical growth.
• Angiotensin-converting enzyme inhibitors: improve blood flow to all organs in the system, including the heart.
• Antiarrhythmics: improve the contractile capacity of the heart.

In moderate and severe cases, treatment will aim at stabilizing the patient and optimizing their general state of health. In the long run, the child may require surgery or even transplants, so it’ll be mandatory to improve nutritional status and the functionality of all body organs.

What are the most common complications?

When the detection of heart failure in children doesn’t occur in time, the deterioration of the body is progressive until it reaches irreversible stages, in which case the most viable option will be heart transplantation.

In those cases in which HF detection takes place in the early stages or before it occurs (for example, with the timely detection and correction of congenital heart disease), the prognosis may be more encouraging. This will depend, in large part, on ensuring access to necessary health care and making sure the patient receives the appropriate treatments.

Living with heart failure

As you can see, the potential complications of HF are serious. However, with proper treatment, it’s often possible to achieve a balanced state of health that allows a normal life. It’s important to accompany the child and their family from diagnosis and at every stage of the disease because the outcome will depend largely on this.

However, living with heart failure is possible! Every day, experts are working to improve diagnostic strategies and therapeutic offers. Of course, this is a very desirable goal to achieve. But the most important thing today is educating the healthcare system and the community about the importance of early diagnosis.