Congestive Heart Failure

What Is Heart Failure?

Heart failure is when the heart can't deliver as much blood to the body as it should. If that happens, blood and oxygen can’t get to the organs. Treatment can help with heart failure and sometimes control it.

What Is Congestive Heart Failure?

Congestive heart failure (CHF) is when blood backs up (gets “congested) in the heart. This leads to fluid buildup in the lungs and body. 

What Happens in Congestive Heart Failure?

The heart has two upper chambers (the left atrium and right atrium) and two lower chambers (the left ventricle and right ventricle). Normally, blood:

1. comes from the body into the right atrium
2. flows to the right ventricle, which pumps it out to the lungs to pick up oxygen
3. comes from the lungs into the left atrium
4. flows into the left ventricle which pumps it out to the body to deliver oxygen

But in heart failure, the heart can’t work as it should and not enough blood and oxygen get to the organs. And blood backs up in the heart and then into the lungs. 

What Happens When Blood Backs Up in the Heart?

If blood backs up in the heart, there’s no room for the blood that's returning from the body and lungs. So that blood stays in the blood vessels of the lungs and the body. Some fluid from the blood vessels leaks out into the tissues. This leads to fluid in the lungs (pulmonary edema) and swelling in the legs and ankles (edema).

What Causes Congestive Heart Failure?

CHF in children usually happens because:

• Too much blood flows through the heart (for example, from a congenital heart defect or severe anemia).
• The heart isn't pumping normally (for example, from a congenital heart defect or cardiomyopathy).
• The heart can't relax normally.

What Are the Signs & Symptoms of Congestive Heart Failure?

In its early stages, congestive heart failure might not cause any symptoms. As it gets worse, it can make a child:

• breathe fast
• tire easily
• not feed and grow well
• have swollen ankles, feet, or belly

How Is Congestive Heart Failure Diagnosed?

To diagnose CHF, doctors do an exam and run tests such as:

• a chest X-ray
• an electrocardiogram (ECG or EKG)
• an echocardiogram
• pulse oximetry
• blood tests
• exercise testing for children over 4 years old. Also called a "stress test,” this can show how well the heart beats while the child exercises.
• cardiac catheterization
• other imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI)

How Is Congestive Heart Failure Treated?

To treat CHF, doctors give medicines to:

• help the heart beat stronger
• help the heart beat at the right rate
• reduce the amount of fluid in the body
• lower the blood pressure so the heart doesn’t have to work so hard to push blood out of the heart into the blood vessels

Some kids might need a pacemaker to help their heart beat at the right rate. Doctors do surgery to place this small device under the child’s skin and muscle. It uses electrical impulses to control the speed and rhythm of the heartbeat.

If heart failure keeps getting worse, doctors can use one of these until the child gets better:

• a ventricular assist device (VAD) to take over the work of the heart 
• extracorporeal membrane oxygenator (ECMO) to take over the work of the heart and lungs

Sometimes, treating the cause of the CHF (such as surgery to fix a congenital heart defect) cures the heart failure. Very rarely, a heart transplant is needed.

How Can Parents Help?

If your child has congestive heart failure, learn as much as you can about the condition, its cause, and its treatments. This will help you work with the care team and better help your child cope. Be sure to ask when you have questions.

To find support, talk to anyone on the care team. Resources are available to help you and your child. You can also learn more online at:

• Nemours.org
• The American Heart Association

You play a big role in your child's treatment. Keep a record of:

• your child’s medical appointments, medicines, and any symptoms 
• any special instructions for taking care of your child at home
• questions you have for the care team