ABSTRACT
Inability of the heart to maintain cardiac output in childhood is usually associated with congenital heart disease which causes either pressure or volume overload. Signs and symptoms almost always develop in the first year of life, with biventricular failure resulting in pulmonary venous and hepatic congestion. Occasionally there is a non-cardiac cause such as fluid overload or anaemia. Heart failure is uncommon in older children. Specific disease of the heart muscle (infective, metabolic, drugs) may impair cardiac function resulting in a dilated cardiomyopathy. Pericarditis may result in an effusion or fibrosis which can impede cardiac function. Management of heart failure is aimed at removing treatable causes, reducing sodium and water load, improving myocardial contractility and general supportive measures such as maintaining good nutrition.
