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Heart failure in children

Congestive heart failure - children; Cor pulmonale - children; Cardiomyopathy - children; CHF - children; Congenital heart defect - heart failure in children; Cyanotic heart disease - heart failure in children; Birth defect of the heart - heart failure in children

Heart failure is a condition that results when the heart is no longer able to effectively pump oxygen-rich blood to meet the oxygen needs of the body's tissues and organs.

Heart failure can occur when:


The heart is composed of two independent pumping systems. One is on the right side, and the other is on the left. Each has two chambers, an atrium and a ventricle. The ventricles are the major pumps in the heart.

The right system receives blood from the veins of the whole body. This is "blue" blood, which is poor in oxygen and rich in carbon dioxide.

The left system receives blood from the lungs. This is "red" blood which is now rich in oxygen. Blood leaves the heart through the aorta, the major artery that feeds blood to the entire body.

Valves are muscular flaps that open and close so blood will flow in the right direction. There are four valves in the heart.

One common way heart failure occurs in children is when the blood from the left side of the heart mixes with the right side of the heart. This leads to an overflow of blood into the lungs or one or more chambers of the heart. This occurs most often due to birth defects of the heart or major blood vessels. These include:

Abnormal development or damage to the heart muscle is the other common cause of heart failure. This may be due to:


As the heart's pumping becomes less effective, blood may back up in other areas of the body.

Symptoms of heart failure in infants may include:

Common symptoms in older children are:

Exams and Tests

The health care provider will examine your child for signs of heart failure:

Many tests are used to diagnose and monitor heart failure.

A chest x-ray and an echocardiogram are most often the best first tests when heart failure is being evaluated. Your provider will use them to guide your child's treatment.

Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart. It may be done to measure pressure, blood flow, and oxygen levels in different parts of the heart.

Other imaging tests can look at how well your child's heart is able to pump blood, and how much the heart muscle is damaged.

Many blood tests may also be used to:


Treatment often involves a combination of monitoring, self-care, and medicines and other treatments.


Your child will have follow-up visits at least every 3 to 6 months, but sometimes much more often. Your child will also have tests to check heart function.

All parents and caregivers must learn how to monitor the child at home.You also need to learn the symptoms that heart failure is getting worse. Recognizing the symptoms early will help your child stay out of the hospital.


Your child will need to take medicines to treat heart failure. Medicines treat the symptoms and prevent heart failure from getting worse. It is very important that your child take any medicines as directed by the health care team.

These medicines:

Your child should take medicines as directed. DO NOT take any other drugs or herbs without first asking the provider about them. Common drugs that may make heart failure worse include:

The following surgeries and devices may be recommended for some children with heart failure:

Outlook (Prognosis)

Long-term outcomes depend on a number of factors. These include:

Often, heart failure can be controlled by taking medicine, making changes in lifestyle, and treating the condition that caused it.

When to Contact a Medical Professional

Call your provider if your child develops:

Go to the emergency room or call the local emergency number (such as 911) if your child:


Aydin SI, Siddiqi N, Janson CM, et al. Pediatric heart failure and pediatric cardiomyopathies. In: Ungerleider RM, Meliones JN, McMillian KN, Cooper DS, Jacobs JP, eds. Critical heart disease in infants and children. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 72.

Bernstein D. Heart failure. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 442.

Starc TJ, Hayes CJ, Hordof AJ. Cardiology. In: Polin RA, Ditmar MF, eds. Pediatric Secrets. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 3.


Review Date: 10/12/2018  

Reviewed By: Scott I. Aydin, MD, Assistant Professor of Pediatrics, Albert Einstein College of Medicine, Division of Pediatric Cardiology and Critical Care Medicine, The Children's Hospital at Montefiore, Bronx, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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