This document discusses heart failure in children, including its definition, types, causes, symptoms, diagnosis, complications, and management. Heart failure occurs when the heart cannot pump enough blood to meet the body's needs. In children, common causes include congenital heart disease, rheumatic heart disease, and cardiomyopathy. Symptoms vary by age but may include feeding issues, sweating, poor growth, and edema. Diagnosis involves exams, chest x-rays, electrocardiograms, and echocardiograms. Complications can include arrhythmias, infections, and damage to other organs. Treatment focuses on supportive care, medications to improve heart function, and treating the underlying cause. Prognosis depends on the cause,

1. Heart Failure in Children
Definition, Types, Patho-physiology, Etiology,
Clinical Features, Complications, Management
Prognosis
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

2. Al Quran surah Al Shuaraa 26:88-89
On the day of judgement, wealth or family will not be of any benefit;
only the person who comes with a pure heart will be successful

3. Heart
• Human heart beats 115,000
times each day
• Human Heart pumps 7500
liters of blood in 24 hours
• Human Heart supplies
nutrients to each cell of the
body through blood vessels
which are 100,000 km long

4. Cardiac Failure
• Definition: Failure of cardiac output to meet metabolic
needs of the body
• Cardiac Failure results in inadequate oxygen delivery to
body tissues
• Compensated Heart Failure: compensatory mechanisms
increase the cardiac output and the oxygen delivery
• Decompensated Heart Failure: compensatory mechanisms
start failing and cardiac output starts falling

5. Cardiac Output
• Cardiac Output = Heart Rate X Stroke Volume
• Stroke volume is dependent on three factors:
• • Preload - (blood volume overload, End Diastolic Volume)
• • Afterload - resistance (pressure) against which the heart
must pump blood, systemic vascular resistance
• • Contractility of heart - Cardiac Performance

6. Volume overload increases contractility of Heart

7. Compensatory Mechanisms in Heart Failure

8. Types of Heart Failure
• Compensated Heart Failure –
• compensatory mechanisms are successful
- increased heart rate and force of contraction (chronotropic and
ionotropic effect)
- stroke volume increased
- cardiac output maintained
• Decompensated Heart Failure –
• compensatory mechanisms fail
- cardiac contractility low
- cardiac output decreased
- venous congestion
- edema

9. Decompensated Heart Failure

10. Pathology
• Cardiac Hypertrophy
• Pulmonary edema
• Venous congestion
• Dependent edema (pitting edema)

11. Etiology
• Volume overload - L to R shunts in heart, Fluid overload,
Severe anemia
• Decreased Contractility - Myocarditis, Cardiomyopathy,
Hypoxia, Hemosiderosis
• Pressure overload – Systemic Hypertension, Pulmonary
Hypertension (cor-pulmonale)
• Diastolic Dysfunction – Pericardial effusion

12. Heart Failure in Children
• Congenital Heart Disease – VSD, ASD, PDA
• Rheumatic Fever, Rheumatic Heart Disease - MR
• Cardiac Arrhythmia - SVT, VT
• Severe anemia
• Pericardial effusion
• Hypertension – Renal diseases (Acute glomerulonephritis,
CKD)
• Pulmonary hypertension (cor-pulmonale)
• Cardiomyopathy

13. Clinical Features

14. Clinical Scenario
• A 3 months old baby presents to the OPD with complaints of
frequent cough and cold for the last 2 months.
• Baby is on mother feeding, but takes feeding for a short time
only. He remains fussy and cries often
• Weight of the infant is 4 kg.
• On examination, his heart rate is 150/min and respiration is
60/min.
• Chest examination: apex beat at 5th intercostal space 1 cm left to
mid-clavicular line. A pan-systolic murmur is audible at left lower
sternal border.
• Abdominal examination shows enlarged liver palpable by 4 cm
below the right costal margin
• What is your diagnosis ?

15. Symptoms
• Infants :
• Feeding problems, sweating
• Oliguria
• Growth failure
• Older children:
• Exertional dyspnea
• Fatigue
• Edema
• Palpitation
• Pain abdomen

16. Signs
• Tachycardia (fast heart rate)
• Tachypnea (fast breathing )
• Cardiomegaly (shifted apex)
• Hepatomegaly
• JVP raised
• Edema – pulmonary, systemic
• Growth failure

17. Diagnosis
• X – ray Chest (cardiomegaly)
• ECG – (ventricle hypertrophy)
• Echocardiography –
• Low Ejection Fraction (N = 55-65%)
• Oxygen saturation (Pulse oximetry) – low in
pulmonary edema

18. Other Investigations
• CBC
• Electrolytes
• Cardiac Biomarkers – increase in ventricular dilation
- Brain natriuretic peptide (BNP) - more than 100 pg/mL
- N -terminal prohormone BNP (NT-pro BNP)
• Liver Function Tests
• Renal Function Tests

19. Complications
• Cardiac Arrhythmia
• Thrombo-embolism
• Repeated chest infections
• Pulmonary edema
• Liver dysfunction
• Renal failure
• Electrolyte Imbalance
• Failure to thrive – low weight and height

20. Management

21. Supportive Management
• Comfortable environment
• Rest
• Position
• Feeding
• Fluid restriction
• Anemia – iron supplements
• Blood transfusion

22. Specific Management
• Diuretics
• Digoxin
• ACE inhibitors (ACEI, ARB)
• Neprilysin inhibitors
• Beta-blockers
• Treat the cause of Heart Failure

23. Prognosis
• Etiology of HF
• Severity of HF
• Response to treatment

24. Clinical Assessment of Severity in Adults

25. Clinical Assessment of Severity in Children

26. Medical Profession