Heart Failure in Children

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Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, is Kentucky and Southern Indiana’s only complete resource for children with heart failure. Our pediatric cardiologists are board certified and fellowship trained to care for your child.

Our physicians also are professors at the University of Louisville School of Medicine. They are at the forefront of new treatments, training the next generation of heart failure specialists. The experience and expertise of Norton Children’s Heart Institute physicians make them leaders in positive outcomes for heart failure in children.

It’s our goal to help children recover from heart failure with as little intervention as possible. Most children recover from their heart failure. However, some children require more aggressive treatment including continuous medication infusions, or even a heart transplant in order to have the best chance at survival and living a full life.

Norton Children’s has a network of outreach diagnostic and treatment services conveniently located throughout Kentucky and Southern Indiana.

Our team of specialists from across Norton Children’s Heart Institute treats serious health conditions linked to heart failure, including muscular dystrophy and neuromuscular disorders. You can draw strength, comfort and confidence from our highly trained specialists.

Heart failure occurs when the heart can’t pump enough blood to the body’s other organs. Heart failure can have many causes, including heart conditions that are present at birth, heart valve disease and an abnormal heart muscle. Heart failure can also occur if the heart beats too fast for long periods of time.

With heart failure, the heart is working, but not at 100%. This may lead to different issues, depending on what is causing heart failure:

  • If the left ventricle isn’t pumping as it should, blood flow from the heart to the body may be slow. This can cause:
    • Fluid to back up in the lungs, which can lead to breathing issues
    • Issues with other organs, such as the kidneys or intestines, because they aren’t getting enough blood
  • If the right ventricle isn’t pumping as it should, blood flow from the heart to the lungs may be slow. This can cause:
    • Fluid to back up in tissues, which can lead to swelling (edema) in the body or liver
  • Structural issues in the heart that are present at birth (congenital heart defects) can also cause heart failure. The exact effects depend on the type of heart defect.

Heart Failure Symptoms

Symptoms In Babies

Heart failure may not appear right away. It may take a couple of days or up to eight weeks for symptoms of heart failure to appear, depending on the exact cause and severity of the heart failure.

Symptoms may include:

  • Fast heartbeat and fast breathing
  • Delays in meeting developmental milestones
  • Enlarged liver
  • Working hard to breathe while feeding and trouble gaining weight
  • Fatigue
  • Puffy eyes or feet (when the right side of the heart fails)
  • Sweating more than usual
  • Trouble sleeping, being grumpy and excessive crying

Symptoms in Older Children

It can be harder to spot the signs of heart failure in older children at first. Pay attention to changes in your child’s behavior and how symptoms show up over time.

Symptoms include:

  • Breathing too fast
  • Cold hands and feet
  • Not tolerating exercise well; quickly becoming short of breath
  • Dizziness and fainting
  • Swelling (edema) in the ankles or abdomen
  • Little to no energy, especially compared to their peers
  • Lightheadedness
  • Palpitations or irregular heartbeat
  • Passing out while exercising
  • Poor appetite
  • Shortness of breath, even during light exertion
  • Tiring easily

Heart Failure Causes

Heart failure can happen to children:

  • As a result of a heart condition they are born with that causes blood to mix inside the heart; an “overcirculation failure”
  • Due to the heart becoming damaged so it can’t contract as it should; a “pump failure”

The first type, overcirculation failure, is more common in babies and younger children. With this type, the heart pumps as it should, but the blood takes a route that is not efficient. It can take a wrong route, such as bringing too much blood to the lungs, which over time puts strain on the heart and lungs. This type of heart failure is caused by heart defects that children are born with, such as a hole or other structural issue in the heart.

Examples of these heart defects include:

  • Atrial septal defect: A hole between the two atria, the upper chambers of the heart. If the hole is so big that it causes extra blood flow to the lungs, blood eventually backs up in the lungs, and the over worked heart is not able to effectively pump blood out to the body to meet the body’s energy needs.
  • Atrioventricular canal defect: A large hole in the center of the heart, creating a communication between the atria, ventricles or both. If the hole is so big that it causes extra blood flow to the lungs, blood eventually backs up in the lungs, and the overworked heart is not able to effectively pump blood out to the body to meet the body’s energy needs.
  • Patent ductus arteriosus: All babies need the ductus arteriosus, a blood vessel between the aorta and main pulmonary artery, while they’re developing during pregnancy. It usually closes within the first couple of days of life. When it doesn’t close, it’s called patent ductus arteriosus. It causes extra blood flow to the lungs. This is very common in premature babies, but can cause blood to eventually back up in the lungs and the over worked heart is not able to effectively pump blood out to the body to meet the body’s energy needs.
  • Ventricular septal defect: This is a hole between the two lower pumping chambers (ventricles) of the heart. If the hole is so big that it causes extra blood flow to the lungs, blood eventually backs up in the lungs, and the over worked heart is not able to effectively pump blood out to the body to meet the body’s energy needs.

The second type of congestive heart failure, pump failure, happens when the heart muscle is weak and unable to pump the amount of blood the body needs.

In babies, causes can include:

  • Cardiomyopathy: A weak heart muscle caused by an infection or irregular heartbeat
  • Conditions such as critical aortic stenosis or critical coarctation of the aorta, mitral stenosis: The structures on the left side of the heart are so small or narrow that blood has a hard time leaving the heart, causing a backup into the lungs

In older children with no congenital heart issues, causes can include:

Diagnosing Heart Failure in Children

A pediatric cardiologist can make a diagnosis of congestive heart failure. The pediatric cardiologist may run several tests and other procedures to discover if your child has heart failure including the cause of heart failure, including:

  • Cardiac MRI (magnetic resonance imaging): This test uses radio waves, magnets and a computer to form 3D pictures of the heart. These pictures can show structural issues (such as an enlarged ventricle) and help diagnose cardiomyopathies or myocarditis.
  • Chest X-ray: This shows pictures of the heart and lungs, and can show an enlarged heart and extra blood flow or fluid in the lungs. Repeated tests can show how heart failure is changing.
  • Echocardiogram (echo): This test uses sound waves (ultrasound) to produce images of the heart and blood vessels’ structures on a screen. It can show the structure and function of the heart. Norton Children’s Heart Institute has 28 tele-echo locations throughout Kentucky and Southern Indiana.
  • Electrocardiogram (ECG or EKG): This test checks the heart’s electrical activity to show damage or irregular rhythms.
  • Exercise test: Older children may have this test to show what symptoms their heart failure causes and how the condition is progressing.
  • Heart catheterization: This invasive procedure studies the heart’s structure and function, and provides direct pressure measurements of the heart.

Babies, children and teens with heart failure can receive comprehensive and coordinated care from the Norton Children’s heart failure, cardiomyopathy and heart transplant team. Using precise diagnostic tools and years of training, our pediatric cardiologists use medications to treat heart failure. If needed, Norton Children’s Heart Institute has the ability to implant a ventricular assist device (VAD) or perform a heart transplant to address the most severe cases of heart failure. Specialists within the Norton Children’s network also can provide care for serious health conditions that are closely linked to heart failure, such as muscular dystrophy and other neuromuscular disorders.

Why Choose Norton Children’s Heart Institute

  • Norton Children’s Hospital has been a pioneer in pediatric cardiothoracic surgery, performing Kentucky’s first pediatric heart transplant in 1986 and becoming the second site in the United States to perform an infant heart transplant.
  • The American Board of Thoracic Surgery has certified our cardiothoracic surgeons in congenital heart surgery.
  • The Adult Congenital Heart Association has accredited Norton Children’s Heart Adult Congenital Heart Disease Program as the only comprehensive care center in Kentucky and Indiana treating adults born with a heart defect.
  • More than 5,000 children a year visit Norton Children’s Heart Institute for advanced heart care.
  • Norton Children’s Heart Institute has offices across Kentucky and Southern Indiana to bring quality pediatric heart care closer to home.
  • The Jennifer Lawrence Cardiac Intensive Care Unit (CICU) at Norton Children’s Hospital is the largest dedicated CICU in Kentucky, equipped with 17 private rooms and the newest technology available for heart care.
The Adult Congenital Heart Association has recognized Norton Children's Heart Institute for its expertise treating adult congenital heart disease.

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