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## SYMPTOMS Congestive heart failure symptoms vary widely depending upon the type and degree the primary cause, and the child's age. Because of increased pressure in the lungs after birth, symptoms may be delayed in infants for the first week or two. ### Infants * **Tachycardia** and **low cardia...

## SYMPTOMS Congestive heart failure symptoms vary widely depending upon the type and degree the primary cause, and the child's age. Because of increased pressure in the lungs after birth, symptoms may be delayed in infants for the first week or two. ### Infants * **Tachycardia** and **low cardiac output** occur with both types of heart failure resulting in sweating, pallor, and hypotension: * **Left failure:** Infants typically suffer respiratory distress with **tachypnea** (rapid breathing), **grunting respirations**, **sternal retraction**, and **rales**, but the most common symptom is **failure to thrive** and **difficulty eating**, often leaving the child **exhausted and sweaty**. * **Right failure:** Infants may have more **generalized edema of lower extremities**, **distended abdomen from ascites**, **hepatomegaly** (enlarged liver) and **jugular venous distension**. ### Older Children * Children typically suffer from inability to **tolerate activity or exercise**, becoming **short of breath on exertion**. Appetite is often poor with **weight loss**. ### Adolescents * Symptoms are similar to those of adults with **shortness of breath on exertion**, **peripheral edema**, and **poor appetite**. **CHF** (Congestive Heart Failure) may be caused by the use of illicit drugs if there is no structural or acquired heart disease. ## MEDICAL TREATMENTS Management of congestive heart failure (CHF) in infants and children can be difficult. It is extremely important to establish the etiology and to treat the underlying cause. For infants with structural cardiac abnormalities, surgical repair may be needed to resolve the CHF. Medical treatments can relieve symptoms: * **Diuretics:** Reduce pulmonary and peripheral edema. Commonly used diuretics include furosemide (Lasix®), metolazone, and hydrochlorothiazide. * **Antihypertensives:** Decrease heart workload. Medications include captopril (an ACE inhibitor) and propranolol (a non-specific β-blocker). * **Cardio glycoside (Digoxin):** May relieve symptoms if diuretics and antihypertensives are not successful. * **Inotropic agents:** Increase contractibility of the heart. Agents include dopamine and dobutamine. * **High caloric feedings:** Provide sufficient nutrients. May be provided orally and by bottle (for infants) or per nasogastric feeding tube. * **Oxygen:** Increase oxygenation and may relieve some dyspnea. * **Activity restriction:** Reduces exertional stress on the heart. ## CHRONIC HEART FAILURE VS. ACUTE HEART FAILURE ### Chronic Heart Failure Chronic heart failure develops more slowly with the myocardium damaged by lack of adequate oxygenation and nutrition, so that the myocardial cells begin to die, creating areas of necrosis, which in turn stimulates the production of fibroblasts, which replace cells with deposits of collagen, creating a fibrotic resistant myocardium. Existing myocytes increase in size but lose strength. There is cardiac dilation and increasing vascular resistance (afterload). ### Acute Heart Failure Acute heart failure can occur with sudden onset, with the body attempting to compensate for circulatory malfunction by protecting blood flow to vital organs. There is an increase in the contractibility of the myocardium but peripheral vasoconstriction. Fluid and sodium are retained to control hypotension. However, the increased contractibility and heart rate increases the need for oxygen beyond the capacity of the heart, and so create the strain needed to maintain arrhythmias.