Congestive Heart Failure

What is Congestive Heart Failure?

• Children born with certain types of heart problems are at risk for developing congestive heart failure (CHF). Not all children with heart defects will have congestive heart failure. Congestive heart failure occurs when the heart must work harder to meet the demands of the body. It does not mean the heart is going to suddenly fail or stop working.
• When the heart can't work as it should, fluid can build up in the lungs and rest of the body, causing difficult breathing and swelling.
• Congestive heart failure occurs gradually. If your child has congestive heart failure, you will notice some signs and symptoms that happen over a period of time. The type and number of symptoms are different in each child but it is usually some combination of the following signs.

Signs and Symptoms of Congestive Heart Failure

• Persistent fast breathing
  The best time to observe your child's breathing is while they are sleeping. Children naturally breathe faster when awake or crying.

• Hard breathing
  You may see muscle pulling or "retractions" between and below the ribs and/or the breast bone.
  You may see some widening of the nostrils when the child breathes in.
  You may hear a grunting or wheezing sound with breathing.
  Some children may have more trouble breathing when they are lying down.

• Cough and congestion
  Sometimes this is difficult for parents to tell if these symptoms are related to congestive heart failure or a respiratory illness. However, a fever and nasal drainage generally is associated with a respiratory illness.

• Changes in skin color
  Look for a grayish, mottled color or paleness.

• Irritability/restlessness
  
• Sweatiness or diaphoresis
  You may notice cool clammy skin or cool sweat on your child's forehead.

• Decreased amount of urine
  A baby may have fewer wet diapers (less than 6-8 a day).

• Swelling or edema
  Look for puffiness in your child's feet and hands and around the eyes.

• Changes in activity
  Look for a decrease in activity, an increase in time spent sleeping or tiring more easily.

• Feeding difficulties and poor weight gain
  These problems may happen because your child burns more calories even at rest, uses too much energy to eat or has a poor appetite.

Treatment of Congestive Heart Failure

Congestive heart failure is treated by finding and removing the cause, if possible, or by giving medicines to help the heart work more easily. The medicines that are usually given are:

Digoxin: This drug slows and strengthens the pumping action of the heart muscle.

Diuretics: These drugs help to remove extra fluid from the body tissues.
Expect your child to urinate more. Common diuretics used are Lasix, Aldactone and Diuril.

Captopril: This drug enlarges the blood vessels slightly, lowering the Blood pressure and making it easier for the heart to pump blood.

Other things that you can do to help the heart work more easily are:

• Provide quiet areas for rest when the child needs some.
• Avoid extreme hot or cold temperatures.
• Avoid people who are obviously sick.

2006: Information reviewed and approved by Laura Bell, RN, MSN, PNP Pediatric Cardiac Surgery and Lynda Dettling RN, BSN.

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