Heart
Failure
Heart
failure, also called congestive heart failure,
is a condition in which the heart cannot pump
enough oxygenated blood to meet the needs of the
body's other organs. The heart keeps pumping,
but not as efficiently as a healthy heart. Usually,
the loss in the heart's pumping action is a symptom
of an underlying heart problem.
Heart
failure often occurs in children with congenital
(present at birth) heart defects. Other medical
problems that can cause heart failure include,
but are not limited to, the following:
- systemic right ventricle
(right ventricle is the only ventricle or the
right and left ventricles are transposed so
that the right ventricle pumps blood out to
the body rather than the lungs) that is unable
to meet demand
- inefficient pumping
of the ventricles due to enlargement of the
heart and/or too much volume in the circulatory
system
- heart valve disease
caused by past rheumatic fever or other infections
- infections of the heart
valves and/or heart muscle (i.e., endocarditis)
- cardiac arrhythmias
(irregular heartbeats)
- cardiomyopathy, or
another primary disease of the heart muscle
- chronic lung disease
- anemia
- high blood pressure
(hypertension)
- hemorrhage (excessive
bleeding)
- post-operative complications
over time, following repair or palliation procedure(s)
Many
congenital heart defects have the potential to
lead to heart failure over time, whether or not
the defect is treated surgically. Congenital heart
defects that more often develop heart failure
include, but are not limited to, the following:
- transposition of the
great arteries
- congenitally corrected
transposition of the great arteries
- tetralogy of Fallot
- pulmonary stenosis
- Ebstein's anomaly of
the tricuspid valve
- single ventricle
- aortic or mitral valve
disease
Heart
failure can affect the right side of the heart,
the left side of the heart, or both sides.
When
the right side of the heart begins to function
less efficiently, it is unable to pump much blood
forward into the vessels of the lungs. Because
of the congestion in the right side of the heart,
blood flow begins to back up into the veins. Eventually,
swelling is noticed in the feet, ankles, eyelids,
and abdomen due to fluid retention.
When
the left side of the heart fails, it is unable
to pump blood forward to the body efficiently.
Blood begins to back up into the vessels in the
lungs, and the lungs become stressed. Breathing
becomes faster and more difficult. Also, the body
does not receive enough blood to meet its needs,
resulting in fatigue and poor growth.
The
following are the most common symptoms of heart
failure. However, each child may experience symptoms
differently. Symptoms may include:
- visible swelling of
the legs, ankles, eyelids, face, and (occasionally)
abdomen
- fast breathing during
rest or exercise
- shortness of breath
or labored breathing
- fatigue
- a child needing to
take frequent rest breaks while playing with
friends
- nausea
- falling asleep when
feeding or becoming too tired to eat
- lack of appetite
- weight gain over a
short period of time, even when the appetite
is poor
- cough and congestion
in the lungs
- sweating while feeding,
playing, or exercising
- breathing difficulty
with activity, especially while feeding, walking,
or climbing stairs)
- loss of interest in
feeding (poor appetite, loss of muscle mass,
overall weight loss)
- failure to gain weight
- swelling around the
eyes or over the flanks (between the ribs and
the upper border of the hip bone)
- abdominal distension
(enlargement) and/or pain over the right side
(liver area)
- change in skin temperature
and color (cold and clammy, or sweaty, flushed,
and warm)
The
severity of the condition and symptoms depends
on how much of the heart's pumping capacity has
been affected.
The
symptoms of heart failure may resemble other conditions
or medical problems. Always consult your child's
physician for a diagnosis.
Your
child's physician will obtain a complete medical
history and physical examination, asking questions
about your child's appetite, breathing patterns,
and energy level. Other diagnostic procedures
for heart failure may include:
- blood and urine tests
- chest x-ray - a diagnostic
test which uses invisible electromagnetic energy
beams to produce images of internal tissues,
bones, and organs onto film.
- electrocardiogram
(ECG or EKG) - a test that records the electrical
activity of the heart, shows abnormal rhythms
(arrhythmias or dysrhythmias), and detects problems
with the heart muscle.
- echocardiogram (echo)
- a noninvasive test that uses sound waves to
produce a study of 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.
Specific
treatment for heart failure will be determined
by your child's physician based on:
- your child's age, overall
health, and medical history
- extent of the disease
- your child's tolerance
for specific medications, procedures, or therapies
- expectations for the
course of the disease
- your opinion or preference
If heart
failure is caused by a congenital (present at
birth) heart defect or an acquired heart problem
such as rheumatic valve disease, surgical repair
of the problem may be necessary. Medications are
often helpful in treating heart failure initially.
Eventually, medications may lose their effectiveness
and many congenital heart defects will need to
be repaired surgically. Medications may also be
used after surgery to help the heart function
during the healing period.
Medications
that are commonly prescribed to treat heart failure
in children include the following:
- digoxin - a medication
that helps strengthen the heart muscle, enabling
it to pump more efficiently.
- diuretics - helps
the kidneys remove excess fluid from the body.
- potassium-sparing
diuretics - helps the body retain potassium,
an important mineral that is often lost when
taking diuretics.
- potassium supplements
- replaces the potassium lost when taking diuretics.
- ACE (angiotensin-converting
enzyme) inhibitors - dilates the blood vessels,
making it easier for the heart to pump blood
forward into the body.
- beta blockers - decrease
the heart rate and blood pressure, and improve
heart function by blocking the stress hormone
adrenalin.
For
more specific information regarding heart failure
treatment, consult your child's physician.
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