Patient Information

Congestive Heart Failure

“Congestive heart failure” is a term we use when the heart is having trouble doing all the work it needs to do without causing symptoms.  It is a common occurrence among children and adults with heart problems, and it is generally treatable.

The heart’s job is to pump enough blood around the body at a high enough pressure to make sure every part of the body is getting enough oxygen and nutrients.  If the heart muscle becomes weak, or the heart has more than the usual amount of work to do, the heart can have a hard time, resulting in congestive heart failure.

Symptoms of Congestive Heart Failure
The heart has two main pumping chambers – the right side pumps blood coming back from the body, and the left side pumps the blood coming back from the lungs.  The symptoms of congestive heart failure depend on which side of the heart is having trouble.  Right heart failure causes blood to “back up” (congestion) in the body, resulting in swelling (edema), fluid in the abdomen or chest (ascites or pleural effusion), and enlargement of organs such as the liver (hepatomegaly).  Left heart failure causes congestion in the lungs, resulting in rapid or difficult breathing and, in babies, difficulty with feeding.  Both kinds of heart failure result in a faster heart rate (tachycardia) and enlargement of the heart on x-ray.  When severe, congestive heart failure in children can result in irritability, poor growth, dizziness or even fainting.  In newborn infants, one sign of congestive heart failure can be marked sweating with feeding, generally combined with fast breathing.

Treatment of Congestive Heart Failure
Often congestive heart failure can be treated by removing the cause.  A valve that is too tight, or a large hole between two pumping chambers, might be repaired, for example.  If it is not possible, or advisable, to remove the cause of congestive heart failure, a child might require treatment with medications and/or nutritional supplements.

There are several types of medications that are useful in congestive heart failure.  Lanoxin (digoxin) helps the heart beat more strongly.  Diuretics such as Lasix (furosemide) cause the kidneys to produce more urine, reducing the amount of fluid in the body and helping the heart work more efficiently.  Many diuretics cause the body to lose too much potassium, and a second medication, Aldactone (spironolactone) or a potassium supplement, may be used as well.  A third class of medications, which includes Captoten (captopril) and Vasotec (enalapril), causes the arteries to relax, reducing the amount of work the heart has to do.  Occasionally there are other types of medications that are used as well. 

Children who require medical treatment for congestive heart failure require close follow up with a pediatric cardiologist to look for side effects of the medications, and to ensure that the doses are correct as a child grows.

In addition to medications, some children benefit from additional nutrition, and may be offered high-calorie formula or nutritional supplements.

For more information about congestive heart failure, as your cardiologist, or visit these web sites:

C.S. Mott Children’s Hospital - http://www.med.umich.edu/1libr/chheart/care02.htm

Lucile Packard Children’s Hospital -http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/cardiac/chf.html

Discovery Health - http://health.discovery.com/diseasesandcond/encyclopedia/2973.html

Winnipeg Children’s Hospital - http://www.hsc.mb.ca/childrens/cf/CHF.htm

Children’s Hospital in Boston - http://www.childrenshospital.org/cfapps/A2ZtopicDisplay.cfm?Topic=Congestive%20Heart%20Failure