Heart failure in children: from the pharmacologic treatment to heart transplantation

Abstract

Heart failure in children occurs basically because of (1) congenital heart defects that lead to pressure or volume overload in the presence or absence of cyanosis; (2) congenital or acquired cardiomyopathies by innate errors in metabolism, muscular dystrophies, infections, drugs, toxins and Kawasaki disease; and (3) myocardial dysfunction after correction of cardiac defects. Its manifestation varies with age. The most common symptoms in infant are tachycardia, tachypnea and dyspnea while suckling; in older children, fatigue and intolerance to exercise; in the adolescents the symptoms are similar to those in the adults. Its treatment can be the correction of the cardiac defect with or without use of drugs to optimize the clinical condition before the surgery. Extended use of anticongestive medication is used in patients with cardiac defects that tend to amend spontaneously. The drugs utilized are digoxin, diuretics, angiotensin inhibitors and beta-blockers. Studies about drugs’ efficacy suggest that digoxin has a modest beneficial effect in children and beta-blockers improve ventricular function. There are few studies about the efficacy of diuretics and about the benefits of angiotensin inhibitors in children, mainly if the ACI has similar effects of adults and if they may affect the child’s growth in long-term period. Heart transplantation has been indicated principally as a treatment for stage D heart failure.