Acute Heart Failure in Children: Causes, Symptoms, Classification, and Treatment

Acute heart failure is a serious condition that occurs when the heart is unable to pump enough blood to meet the body’s needs. In children, acute heart failure can be caused by a variety of factors, including congenital heart defects, infections, myocarditis, and other illnesses.

1. Key Signs of Acute Heart Failure in Children:

• Fatigue with exertion: Children may become easily tired during play, feeding, or other activities.

• Rapid heart rate: The heart beats faster than normal, and it might be noticeable when feeling the chest.

• Congestion: Enlarged liver, rapid breathing, shortness of breath, swelling in the hands and feet, pleural effusion.

• Heart enlargement: This can be detected through echocardiogram or X-ray.

Note: These signs may be subtle in infants and may even be overlooked. Therefore, parents need to carefully observe their children and take them to a doctor as soon as they suspect heart failure.

2. Classifying Heart Failure in Children:

Based on the severity and cause, heart failure in children is categorized into four stages:

• Stage A: At risk for heart failure: Children have risk factors such as congenital heart defects, a family history of heart disease, or other medical conditions.

• Stage B: Structural or functional heart abnormalities but no heart failure symptoms: Children have congenital heart defects but no signs of heart failure yet.

• Stage C: Structural or functional heart abnormalities and heart failure symptoms: Children have congenital heart defects and have developed symptoms like fatigue, rapid heartbeat, and congestion.

• Stage D: Structural or functional heart abnormalities, requiring continuous inotropic medications intravenously or prostaglandins E1 to maintain the ductus arteriosus, and requiring mechanical ventilation and/or circulatory support: Children have severe heart failure requiring aggressive medical interventions to maintain life.

3. Treatment Goals for Heart Failure in Children:

• Increase heart contractility: Medications are used to strengthen the heart’s pumping ability, helping it pump blood more effectively.

• Reduce preload: The amount of blood returning to the heart is reduced using diuretics, which lessens the strain on the heart.

• Reduce afterload: The pressure against which the heart pumps is decreased using vasodilators, making it easier for the heart to push blood out.

4. Medication Groups for Treating Heart Failure in Children:

• Group 1: Decreasing mortality:

• ACE inhibitors (angiotensin-converting enzyme inhibitors)

• ARBs (angiotensin II receptor blockers)

• Aldosterone antagonists: These help regulate water and salt levels in the body, reducing stress on the heart.

• Group 2: Improving symptoms but not prognosis:

• Cardiac glycosides (digoxin): This increases heart contractility, improving blood pumping efficiency.

• Loop diuretics: These help reduce water and salt levels in the body, relieving heart strain.

• Group 3: Increasing risk of death:

• Dobutamine, inamrinone, milrinone, enoximone, ibopamine: These medications can cause serious side effects and are only used in emergencies.

Note: Medication use should be prescribed and monitored by a physician. Do not self-medicate.

5. Treatment Approach for Each Stage of Heart Failure:

• Stage A:

• Manage high blood pressure, diabetes, and lipid disorders.

• Use ACEi/ARBs to prevent heart failure.

• Stage B:

• ACEi, ARBs in all patients.

• Beta blockers in some patients.

• Stage C:

• ACEi, ARBs in all patients.

• Limit salt, water, use diuretics, digoxin.

• Cardiac resynchronization therapy if there is bundle branch block.

• Treat underlying disease: Aldosterone antagonists, BNP.

• Stage D:

• Dopamine, dobutamine.

• Circulatory support devices, heart transplantation.

• Palliative care: Pain medication, sedatives, symptom management, emotional support for the patient and family.

6. Tips:

• Parents should be vigilant in observing their children and consult a doctor immediately if they suspect heart failure.

• Follow the doctor’s instructions regarding treatment and health care for the child.

• Maintain an appropriate diet and engage in light physical activity as directed by the doctor.

• Join support groups or online forums to share experiences and seek assistance from others who have gone through similar situations.

Note: The information provided in this article is for general knowledge and informational purposes only. For proper diagnosis and treatment, consult a cardiologist.