Heart Failure
What is heart failure?
The term heart failure describes the condition of a heart that is not working properly. It does not mean that the heart has stopped beating, but that the heart is not working as well as it should.
The symptoms of heart failure can include:
- Fatigue
- Poor feeding
- Poor weight gain
- Pain in the stomach area
- Diarrhea
- Vomiting
- Shortness of breath
- Difficulty breathing
- Abnormal heart rhythm
Your child’s symptoms will be unique and may depend on how long the heart disorder has been present.
Who gets heart failure?
Heart failure can occur at any age and for many reasons. The two primary causes for heart failure in newborns, infants, children and teenagers are:
Overcirculation failure
This is when a problem with the blood flow pattern causes the heart to pump inefficiently. It can happen in one or more of the chambers of the heart.
The causes of overcirculation failure include:
- Structural heart defects that are holes between the right and left chambers of the heart. Through the holes, the oxygen-poor and oxygen-rich bloods mix inside the heart.
- A defect of blood vessels in the head or other parts of the body. This can cause similar mixing of oxygen-poor and oxygen-rich blood, but outside the heart.
- Abnormal heart valves that do not close properly, causing blood to leak backwards.
- Strep throat infection, which may damage heart valves. Strep throat infection can cause heart values to leak, but is a rare cause of overcirculation failure.
- Low blood iron (anemia), which starves the body of the oxygen it needs to survive.
Pump failure
This is when the heart muscle becomes damaged and no longer contracts (squeezes) normally. It has many potential causes:
- A virus infection can damage otherwise normal heart muscle.
- Problems with the coronary arteries that are present at birth or are the result of infection. This can prevent effective blood flow to the heart muscle itself.
- Certain drugs, including some that treat other medical problems (like cancer or leukemia), can damage the heart muscle.
- The heart’s electrical system may be abnormal from birth or damaged by infection, causing the heart to beat too slow or too fast.
- One of the heart valves may not open properly, causing pressure to back up inside the heart chambers.
- Severe chest trauma may damage the heart. This is a rare cause of pump failure.
- Children with muscular dystrophy may develop problems with their heart muscle.
Learn more about heart failure in children and adolescents and about diseases that can cause heart failure.
What’s special about the way Children’s treats heart failure?
Children’s Heart Transplant Program, established in 1994, performs five to 10 heart transplants every year. We are one of the leading pediatric heart centers in the United States, advancing knowledge with new research and pushing the treatment envelope with innovative procedures.
We have the medical expertise and technology to handle even the most complex cases.
In 2005, Children’s Heart Center surgeons performed a transplant in which a 12-day-old patient and his donor heart had different blood types—only the second surgery of this type successfully executed anywhere in the world.
This “mismatched heart transplant” procedure will dramatically decrease wait times for donor hearts.
Children’s surgeons also moved this same patient from mechanical support to transplant—a first in heart transplant history.
Our heart surgeons, Drs. Gordon Cohen and Lester Permut, almost always operate together, a unique practice among surgeons. We are dedicated to a practice that reduces human error and increases positive outcomes for our patients.
Children’s is the only hospital in Washington state with a pediatric Extra Corporeal Membrane Oxygenation (ECMO) program. ECMO is a heart-lung pump that provides life support when a child’s heart or lungs fail to work properly or need a rest.
In addition to ECMO and VAD—the latest support system used during heart transplant recovery—Children’s has state-of-the-art diagnostic equipment and some of the best heart technicians in the country.
We are committed to excellent patient and organ survival outcomes. We are constantly improving surgery techniques and medication therapy strategies so we can provide the most current treatments and the very best patient care.
What are the options for treating heart failure?
Overcirculation failure
If heart failure is caused by overcirculation due to a congenital heart defect, your child’s doctor may first treat her with certain medications.
They will help:
- Unload the excessive volume of blood
- Lower blood pressure resistance
- Allow the heart’s pump function to improve
Since overcirculation causes poor growth, the doctor may consider nutritional supplements. Other dietary changes such as low-salt and low-fat diets may be helpful.
Following treatment, your child’s condition and symptoms may improve. This is called compensated heart failure. However, the underlying cause may persist. Various kinds of surgery may be necessary to repair the defect.
Pump failure
If the heart failure is caused by pump failure, the same medications may be used. Sometimes medications that lower blood pressure help the heart pump better. At times, surgery may also be needed, such as replacing a damaged heart valve.
Pump failure caused by a too-slow heartbeat often requires a pacemaker. These small, battery-operated devices are like tiny computers. They are implanted under your child’s skin with a small wire connected to the heart. Pacemakers remind the heart to maintain a normal 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 procedure called radiofrequency ablation may be recommended.
The purpose is to correct the abnormal heart rhythm by applying short bursts of radio waves to the area of the heart muscle causing the rapid heart beat.
Your child’s medical team will identify the type of heart failure and make any changes that are needed in her current medication regimen.
As heart failure progresses, your child may require more therapy and prolonged hospital stays.
When all other medical and surgical options have been explored, your doctors may recommend a heart transplant as the best option.