5.2 Heart failure
Causes of congestive heart failure1–4
Most cases of congestive heart failure in childhood result from congenital heart defects.
Left-to-right shunts with increased pulmonary blood flow, e.g. ventricular septal defect (VSD), atrioventricular septal defect (AVSD), patent ductus arteriosus (PDA). atrioventricular septal defect, patent ductus arteriosus.
Acute left heart obstruction, e.g. aortic stenosis, coarctation of the aorta, interrupted aortic arch, hypoplastic left heart syndrome.
Age-based
The causes of congestive heart failure change with age. Congenital heart defects generally present in the first days or months of life. Acquired cardiac disease may occur at any age. The following lists the likely causes at particular ages.
One day to one week of age
Left heart obstruction in duct-dependent lesions, e.g. aortic stenosis, coarctation of the aorta.
Large left-to-right shunt lesions, e.g. large VSD, AVSD, truncus arteriosus.
Clinical manifestations and investigations1–4
Presentation
Infants may present with problems related to feeding, such as sweating, tachypnoea, reduced volume of feeds leading to failure to thrive. Respiratory problems, such as cough, recurrent respiratory infections, tachypnoea and increased work of breathing are prominent. Lower respiratory tract infection may have features in common with congestive cardiac failure (CCF). Cardiac failure should be considered in atypical, persistent or recurrent cases of lower respiratory tract infection (LRTI), particularly in infants.
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