Diagnosis and Management of Heart Failure in Children

Over the last two decades, there has been a notable increase in the pediatric heart failure population. Although there is considerable heterogeneity within pediatric heart failure, there is an increasing prevalence among patients with structural congenital heart disease including after palliation. In this chapter, we define and provide frameworks to categorize pediatric heart failure including by severity and underlying causes. We outline our approach to diagnosing and characterizing pediatric heart failure including pertinent patient history and exam findings, as well as by using complementary imaging techniques, hemodynamic assessments, rhythm evaluations, and exercise testing. Moreover, we describe heart failure management strategies, for both the acute stabilizing and the chronic reverse remodeling phases. For these therapies, we provide evidence for their efficacy, drawing evidence primarily from the adult heart failure literature while acknowledging the need for further research in the pediatric context. Furthermore, we provide a brief overview of emerging heart failure therapies, shedding light on the potential impact for mechanistically-driven treatments. Lastly, we touch on the role of mechanical support and heart transplantation, which are covered in more detail in other chapters.