Etiology, Pathogenesis, and Clinical Presentation of Cardiac Failure in Infants and Children

Introduction

Cardiac failure in infants and children occurs due to various congenital and acquired conditions affecting the heart’s ability to pump efficiently. Understanding its etiology and pathophysiological mechanisms is crucial for proper diagnosis and management.

Etiology of Cardiac Failure in Infants and Children

• Congenital heart defects: Conditions such as hypoplastic left heart syndrome or Tetralogy of Fallot.
• Acquired heart diseases: Myocarditis, cardiomyopathy, or Kawasaki disease.
• Systemic conditions: Hypertension, metabolic disorders, or severe anemia.

Pathophysiological Mechanisms

Cardiac failure results from impaired myocardial function, increased cardiac workload, or abnormal vascular resistance. The mechanisms include:

• Systolic Dysfunction: Reduced myocardial contractility leading to inadequate cardiac output.
• Diastolic Dysfunction: Impaired ventricular filling due to stiffness or hypertrophy.
• Neurohormonal Dysregulation: Activation of the renin-angiotensin-aldosterone system exacerbating fluid retention and vascular resistance.

Clinical Presentation

Symptoms vary based on age and underlying cause but may include:

• Infants: Poor feeding, tachypnea, irritability, and failure to thrive.
• Older children: Fatigue, exercise intolerance, peripheral edema, and orthopnea.

Diagnosis and Management

Diagnosis involves clinical assessment, imaging (echocardiography, MRI), and biochemical markers (BNP, troponins). Treatment includes pharmacotherapy (diuretics, ACE inhibitors), surgical interventions, and supportive care.

Conclusion

Early recognition of cardiac failure in infants and children is vital for optimal management and improved outcomes. A multidisciplinary approach helps provide effective care tailored to the underlying etiology.