Medical Progress
Heart Failure in Children: Etiology and Treatment

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Epidemiology

Heart failure is defined as a clinical and pathophysiologic syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood.2 There is no single diagnostic test that establishes the diagnosis of heart failure; rather, it remains a clinical diagnosis with characteristic signs and symptoms resulting from a combination of circulatory, neurohormonal, and molecular abnormalities.1 Even though it is estimated that there are >5 million adults with heart

Diagnosis and Risk Stratification

The diagnosis of heart failure is made through a series of investigations that include history, physical examination, and diagnostic studies. It is generally possible to not only confirm or refute the presence of heart failure in the pediatric patient but also diagnose the structural abnormality that has caused the heart failure. There is a long list of possible etiologies for pediatric heart failure, but this review will focus on the etiologies that relate to abnormalities of systemic

New Paradigms in Pediatric Heart Failure

The concept of pediatric heart failure as a subspecialty of pediatric cardiology is relatively new. Pediatric heart failure as a discipline emerged from the development of pediatric heart transplant programs in the 1980s and 1990s. As pediatric cardiologists started forming pediatric heart transplant programs, it became apparent that the providers in these programs would need to develop focus and expertise in the management of pediatric heart failure. There were 2 main reasons for this: (1) to

Mechanical Circulatory Support and Heart Transplantation

Heart failure is a progressive disease, and many children with heart failure will progress to end-stage disease even with advanced medical therapy. Heart transplantation offers prolonged survival for patients with end-stage disease; however, the supply of available organs remains small relative to the number of patients that could potentially benefit from them. There are <400 pediatric heart transplants performed annually in the US, and the mortality while waiting for a heart transplant remains

Discussion

Heart failure in children is a serious disease with a high morbidity and mortality, and there is increasing recognition of its importance in child health. The field has evolved over the past decade to meet the growing demand and challenges in the care of these patients, and there has been an explosion in research and utilization of advanced technologies. Ongoing research and a collaborative multidisciplinary approach will likely continue to improve the outcomes of this complex patient

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    The authors declare no conflicts of interest.

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