Diagnosing Heart Failure

Heart Failure and Recovery Program

Diagnosing Pediatric Heart Failure

When Blood Flow Diminishes

Heart failure does not mean the heart has stopped. In most cases, heart failure simply means that the heart muscle is not pumping effectively, thus reducing the flow of oxygenated blood to the rest of the body.


In children and adolescents, heart failure is not always immediately apparent. Pediatric heart failure can be caused by congenital heart defects. But even children born with normal hearts can develop heart muscle dysfunction, (cardiomyopathy) as a result of an infection (myocarditis), or an inherited or metabolic condition that progresses to heart failure. When the exact cause of heart muscle dysfunction is unknown, it is called idiopathic cardiomyopathy.


In pediatric patients, heart failure may result in multiple symptoms such as:

  • elevated heart rate
  • loss of appetite
  • unusual weight gain
  • unusual cough
  • growth failure
  • shortness of breath – sometimes even when lying down

In infants, sweating during feeding can be a clue to heart failure.

Pediatric heart failure can go unnoticed initially and seem to suddenly manifest overnight. Because heart failure can lead to problems with other organs with more overt symptoms, the medical community will sometimes overlook the heart as a cause, while focusing instead on problems occurring with the liver or digestive tract.

Diagnosing Pediatric Heart Failure

Diagnosing Pediatric Heart FailureThere are two types of heart failure, systolic and diastolic.Systolic is the most common form. In these cases, the heart is so weak that blood is unable to move out to the body so it starts to back up into the lungs. With diastolic heart failure, the heart muscle is thick and unable to relax enough to fill properly.

Typically a child may present with shortness of breath or poor feeding/appetite and be referred to a pediatric cardiologist. The evaluation will include a thorough history and physical examination, family history assessment and potentially testing such as pulse oximetry, electrocardiograms, echocardiograms, and if indicated, cardiopulmonary exercise testing.

Once a diagnosis of heart failure is made, treatment options will be taken into consideration based on the severity and symptoms exhibited by the patient.

Understanding prevalence of pediatric heart failure is challenging because there are few national databases tracking this pediatric affliction. As academic institutions and organizations work to quantify and track pediatric patients impacted by heart failure, most believe that over time, we will gain a better understanding of the impact to pediatric patients so we can more consistently treat the effects of heart failure in these young patients.