Heart failure, also known as congestive heart failure, is a condition that develops when the heart doesn’t pump enough blood for the body’s needs.

It can be caused by a structural defect in the heart or if the heart muscle is weak or becomes too stiff to pump the blood properly.

As a result, the muscles and organs don’t get enough oxygen and nutrients. This may cause fluid to build up in the body and make you feel breathless or tired.

What causes heart failure?

Heart failure often occurs in children with congenital heart defects.  Other medical problems that can cause heart failure include, but are not limited to, the following:

• Enlargement of the heart
• Heart valve disease
• Cardiac arrhythmias (irregular heartbeats)
• Chronic lung disease
• Viral infection
• High blood pressure (hypertension)
• Haemorrhage (excessive bleeding)
• Postoperative complications
• Medication side effects, especially those from certain chemotherapy drugs

Signs and symptoms

The main signs and symptoms of heart failure in children include:

Babies

• Poor growth
• Faster breathing
• Faster heart rate
• Difficulties feeding – tiring easily/sweating/feeds frequently for short durations
• Sweaty even at rest
• Sleeps more or has less energy compared to other babies.
• Puffy face, hands or feet
• Delays in reaching developmental milestones.

Signs and symptoms may gradually appear from birth, especially related to your baby’s feeding and growth. Other symptoms may take a few weeks to months to show themselves.

Children

• Poor exercise tolerance
• Lack of energy or tires quickly compared to friends.
• Fainting during exertion
• Poor appetite – weight loss or slow weight gain
• Palpitations (fast heart rate)
• Dizziness
• Fluid retention – puffiness around eyes, feet
• Delays in reaching developmental milestones
• Shortness of breath.

Identifying symptoms in older children can be challenging. Monitoring their exercise tolerance and energy levels compared to friends and siblings without heart conditions may be of some benefit.

Diagnosis

Several tests can be used to help diagnose heart failure including:

• Electrocardiogram (ECG) – measures the electrical activity of the heart.
• Echocardiogram (Echo) – uses sounds waves to produce a moving picture of the heart.
• CT Scan – an X-ray with dye injected to highlight blood vessels.
• Chest X-rays
• Cardiac catheterisation – A thin, flexible tube (called a catheter) in inserted into a blood vessel in the groin and fed up into the heart to measure pressures and oxygen levels, and visualise heart structures using X-ray equipment. The procedure is performed under a general anaesthetic.  Learn more about cardiac catheterisation.
• Blood and urine tests

These tests are typically done because a doctor has heard a heart murmur when examining a child with a stethoscope.

Treatment

For babies and children with heart failure caused by structural defects, the first stage of treatment involves supportive measures including medication, nasogastric tube (NGT) feeds and regular reviews (or check-ups).

If heart failure is caused problems with the heart muscles(too weak or stiff), supportive measures include medication, fluid restriction, exercise programs and regular reviews.

Once supportive measures have been exhausted and a child’s condition progressively gets worse, more intensive measures such as pacemakers, intravenous (IV) medications and, in very rare cases, heart transplantation.

Developed by the Cardiology Department, Queensland Children's Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS253.   Reviewed: January 2024

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.