Heart failure in children: Etiology, clinical manifestations, and diagnosis
- Rakesh K Singh, MD, MS
Rakesh K Singh, MD, MS
- Associate Professor of Pediatrics
- University of California, San Diego
- TP Singh, MD, MSc
TP Singh, MD, MSc
- Associate Professor of Pediatrics
- Harvard Medical School
Heart failure (HF) results from structural or functional cardiac disorders that impair the ability of the ventricle(s) to fill with and/or eject blood. The presentation of pediatric HF is diverse because of the numerous underlying cardiac etiologies (table 1) and varying clinical settings.
The etiology, clinical manifestations, and diagnostic evaluation of HF in children are reviewed here. The management of HF in children is discussed separately. (See "Heart failure in children: Management".)
In the United States, HF is estimated to affect 12,000 to 35,000 children below the age of 19 years in the United States each year [1,2]. HF-related hospitalizations account for approximately 11,000 to 14,000 hospitalizations in children per year in the United States .
PATHOPHYSIOLOGY AND ETIOLOGY
The causes of pediatric HF can be divided into pathophysiologic categories (table 1). This categorization helps in the understanding of the underlying physiology and clinical manifestations of the different causes of pediatric HF, and guides the approach to management. It is important to recognize however, that these categories may overlap in some patients (eg, volume overload and pressure overload can be associated with ventricular dysfunction). (See "Heart failure in children: Management".)
●Ventricular dysfunction − Ventricular dysfunction leads to impaired ejection of blood from the ventricle. Unless specified, ventricular dysfunction implies systolic dysfunction (reduced ventricular contractility). Ventricular diastolic dysfunction implies impaired ventricular filling and noncompliance with abnormally steep pressure-volume relationship resulting in high ventricular filling pressures. Ventricular dysfunction (systolic or diastolic) can occur in children with congenital heart disease (CHD) and in those with structurally normal hearts. Children with CHD may have ventricular dysfunction at presentation, but more commonly develop dysfunction and HF several years (or even decades) following surgical repair of their cardiac defect (ie, "burnt-out" CHD). (See 'Ventricular dysfunction' below.)
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- PATHOPHYSIOLOGY AND ETIOLOGY
- Ventricular dysfunction
- - Structurally normal heart
- - Congenital heart disease
- Volume overload with preserved ventricular contractility
- Pressure overload with preserved ventricular contractility
- STAGING AND SEVERITY
- CLINICAL MANIFESTATIONS
- Physical examination
- DIAGNOSTIC EVALUATION
- Unstable patients
- Chest radiography
- Laboratory tests
- Additional evaluation
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS