Pediatric Heart Failure Diagnosis and Management
Summary
Pediatric heart failure is a multifaceted clinical syndrome characterised by the inability of the heart to meet systemic demands, manifesting with poor growth, fatigue, tachypnoea and fluid retention. The spectrum of aetiologies ranges from congenital structural defects and inherited or acquired cardiomyopathies to rhythm disturbances and extracardiac conditions such as severe anaemia or infection. Diagnosis hinges on careful clinical assessment, echocardiography to evaluate cardiac structure and function, and measurement of circulating biomarkers. Advanced imaging modalities—including cardiac magnetic resonance—offer detailed tissue characterisation, while novel circulating markers may enhance early detection and risk stratification. Management principles draw heavily on adult heart failure paradigms but must account for developmental differences in pharmacokinetics, receptor expression and organ maturation. Standard therapy comprises afterload reduction with angiotensin-converting enzyme inhibitors, modulation of neurohormonal activation with β-blockers and mineralocorticoid antagonists, and judicious use of diuretics. Emerging agents such as heart-rate modulators and combined neprilysin–angiotensin receptor blockers are being evaluated in children. In advanced cases, mechanical circulatory support—including ventricular assist devices—and transplantation represent life-saving options. Comprehensive care involves multidisciplinary teams, tailored nutritional support and close attention to growth and developmental milestones. Worldwide, resource constraints and variable access to diagnostics and therapies highlight the need for adaptable strategies and global collaborations to improve outcomes in diverse settings.
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Pediatric Heart Failure Diagnosis and Management publication trend
The graph below shows the total number of articles in pediatric heart failure diagnosis and management across all publications each year (not limited to Nature Index journals).
Technical terms
Heart failure (HF): A syndrome in which the heart cannot pump sufficient blood to meet the body’s needs.
Ejection fraction (EF): The percentage of blood ejected from the ventricle with each heartbeat.
Cardiomyopathy: A disorder of the heart muscle affecting its structure or function.
Ventricular assist device (VAD): A mechanical pump supporting heart function in advanced heart failure.
Angiotensin-converting enzyme inhibitor (ACE inhibitor): A drug class that reduces blood vessel constriction and fluid retention.
Ivabradine: An agent that selectively reduces heart rate by inhibiting the If pacemaker current.
Sacubitril/valsartan: A combined neprilysin inhibitor and angiotensin receptor blocker that augments natriuretic peptides and suppresses the renin–angiotensin system.
References
- Recent and Upcoming Drug Therapies for Pediatric Heart Failure. Frontiers in Pediatrics (2021).
- Enalapril and Enalaprilat Pharmacokinetics in Children with Heart Failure Due to Dilated Cardiomyopathy and Congestive Heart Failure after Administration of an Orodispersible Enalapril Minitablet (LENA-Studies). Pharmaceutics (2022).
- Chronic Heart Failure in Children: State of the Art and New Perspectives. Journal of Clinical Medicine (2023).
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