Heart Failure

What is heart failure?

Heart failure happens when the heart can’t pump enough blood to the body’s other organs. Many things can cause heart failure, such as congenital heart defects, heart valve disease and abnormal heart muscle. Heart failure can happen if the heart beats too fast or too slow.

In heart failure, the heart still works but not as well as it should. This can lead to different problems, depending on the cause. 

  • If the left ventricle can’t pump well, blood flow from the heart to the body may be slow. This can cause fluid to back up in the lungs, which can cause breathing problems. It can also lead to problems with other organs in the body, such as the kidneys or intestines, if these organs don’t receive enough blood flow from the heart.
  • If the right ventricle can’t pump well, blood flow from the heart to the lungs may be slow. This can cause fluid to back up in the tissues, which can appear as edema of the body or swelling of the liver. Many different problems with the heart structure can lead to heart failure. The exact effects can depend on the structural problems.
  • Heart failure can occur at any age and for many reasons. For newborns, babies, children and teenagers, there are 2 main categories of heart failure: 

    • Birth defects and other problems with the structures of the heart
    • Problems with the heart muscle 

    Children may be born with these problems (congenital), or they may develop them later in life. Heart failure may also happen after open-heart repair of birth defects. This may be a temporary condition (lasting for days) or may persist for a prolonged period (months or years, or, in some cases permanently). 

    Birth defects and other structural problems

    Birth defects are the most common cause of heart failure in babies and children. Defects like aortic stenosishypoplastic left heart syndromecoarctation of the aortaventricular septal defectatrioventricular septal defect, and others sometimes lead to heart failure. They can cause heart failure because they cause problems with blood flow into, out of or within the heart.

    Heart muscle problems

    Diseases of the heart muscle, such as myocarditis or cardiomyopathy, may cause heart failure. These diseases can make the heart muscle unable to pump the way it should. Heart failure can happen if the heart beats too fast or too slow.

The Heart Failure Program at Seattle Children’s

Consistently ranked one of the nation's best cardiology and cardiac surgery programs by U.S. News and World Report.We have the medical and surgical expertise, and the latest technology, to handle the most complex cases of heart failure. Our Heart Failure Program, led by Dr. Yuk Law, is the only one in the Pacific Northwest that specifically treats this disease in children using medical and surgical approaches.



  • Our heart team has treated many children with heart failure, including the most complex cases. Our team includes experts in caring for the very youngest patients — newborns and very young infants with heart failure.

    We have extensive experience with the treatment your child may need, which ranges from medicines to lower the workload of the heart and help the heart pump, to medical devices such as pacemakers and ventricular assist devices, to transplantation.

    Seattle Children’s Heart Transplant Program was established in 1994. We perform an average of 18 heart transplants every year in babies, children, teens and young adults through age 21. Our certified pediatric-trained heart surgeons, Drs. Michael McMullanLester Permut and Mohamed Nuri, operate together, a unique practice among surgeons. We are committed to providing compassionate, innovative care and achieving excellent results.

    We have a pediatric cardiac anesthesia team and a Cardiac Intensive Care Unit ready to care for children who have heart surgery. The doctors who give your child anesthesia are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids.

  • Care often begins before a child is born, when a congenital heart defect is diagnosed through our Prenatal Diagnosis and Treatment Program. We provide accurate diagnosis, thoughtful counseling and pregnancy management.

    We also have a special Adult Congenital Heart Disease Program to transition your child to adult care when they are ready. This program was developed by Seattle Children’s and the University of Washington to help with care throughout your child’s life.

  • When you come to Seattle Children’s, a team of people will take care of your child. Along with your child’s heart doctor (cardiologist), you are connected with other providers, such as cardiac intensivists, newborn specialists (neonatologists), nurses, child life specialists, social workers and others, if their expertise is needed.

    We work together to meet all of your child’s health needs and help your family through this experience. We’ll discuss treatments in ways you can understand and involve you in every decision.

    Read more about the supportive care we offer.

  • Seattle Children’s performed 21 heart transplants in 2015, making it one of the busiest heart centers in the United States. More importantly, our patient outcomes are among the best in the nation, with a three-year survival rate of 92.31%. See our statistics and outcomes.

  • We are pursuing better ways to manage heart failure in children so they can live healthier lives. Our researchers: 

    • Develop tests to help diagnose and monitor heart failure
    • Investigate ways to prevent deaths from sudden, unexpected cardiac arrest
    • Develop ways to protect the heart and kidneys from injury during surgery
    • Study diseases and health problems that happen at the same time as heart failure 

    Read more about our heart failure research.

Symptoms of Heart Failure

Some of your child’s symptoms may depend on whether the left side, right side or both sides of the heart are affected.

Symptoms in babies

These are common symptoms of heart failure in babies: 

  • Having a fast heartbeat and fast breathing
  • Working hard to breathe when feeding (which causes trouble with feeding and gaining weight)
  • Being restless or irritable
  • Sweating more than normal 

Symptoms in children

Young children with heart failure tend to have problems with breathing too fast, getting short of breath and tiring easily. These problems tend to get worse when the child is more active.

Children may have these symptoms: 

  • Edema, or swelling, in the ankles or abdomen (stomach)
  • Cold hands and feet
  • Lightheadedness

Diagnosing Heart Failure

To diagnose this condition, your doctor will examine your child, use a stethoscope to listen to their heart and check their breathing and blood pressure.

The doctor will ask for details about your child’s symptoms, their health history and your family health history.

Chest X-rayselectrocardiography and echocardiography can provide more information about how your child’s heart looks and works.

To tell what caused your child’s heart failure, the doctor may also need to do other procedures, such as an MRI (magnetic resonance imaging) of their heart or a cardiac catheterization.

Treating Heart Failure

Babies, children and teens with heart failure receive comprehensive and coordinated care through our Heart Failure Program.

Doctors use many different treatments to lower the workload of the heart. The goals are to control extra fluid and improve the heart’s ability to pump. Doctors also try to find and treat any condition that caused the heart failure. Some children need other treatments, such as surgery to repair a heart defect or medicine for arrhythmia.

Treatment for heart failure depends on the cause. Your child’s medical team will identify the type of heart failure and talk with you (and your child, if they are old enough) about treatments.

  • Diuretics help the kidneys rid the body of extra water. This lowers the amount of fluid in the lungs and improves circulation. Other medicines are used to help the heart heal so it can function better. To help the heart recover, doctors use medicines such as these: 

    • Angiotensin-converting enzyme (ACE) inhibitors
    • Beta-blockers
    • Digoxin
  • If your child’s heart failure is caused by a heartbeat that is too slow, your doctor may recommend implanting a pacemaker. These small, battery-operated devices are like tiny computers. Doctors place them under your child’s skin. A tiny wire connects the pacemaker to your child’s heart. Pacemakers help your child’s heart maintain a normal rate.

    Read about what to expect with a pacemaker.

  • If your child’s heart failure is caused by a lack of coordination between the heart’s 2 ventricles, your doctor may recommend cardiac resynchronization therapy (CRT).

    CRT uses a special kind of pacemaker. Doctors place a small, battery-operated device under your child’s skin. Tiny wires connect the pacemaker to your child’s ventricles and stimulate them to work in a coordinated way.

  • If a birth defect is the cause of your child's heart failure, they may need surgery.

    Many heart surgeries are designed to restore the heart’s circulation to as normal a level as possible. Babies with complex heart defects need various surgeries, sometimes over several years. Our pediatric heart surgeons use the most advanced techniques and achieve results that are among the best in the nation.

    Learn more about heart surgery at Seattle Children’s.

  • Some children need more than medicines to help the heart pump. For some of those children, a VAD (or mechanical pump) can be used. Most children who receive a VAD will be listed for a heart transplant.

  • If your child’s heart is too damaged, a heart transplant may be needed. The heart transplant team at Seattle Children’s performs an average of 18 transplants each year for children with this or other heart problems that cannot be controlled using other treatments. Read more about our heart transplant program.

    Julie’s Story: From Failing Heart to Transplant

    When myocarditis suddenly threatened her life, Julie traveled from Hawaii to Seattle Children’s to receive a HeartMate II VAD. The VAD kept Julie healthy enough to wait for a heart transplant – and gave her the chance to build her first snowman. Read more.

Contact Us 

Contact the Heart Center at 206-987-2515 to request an appointment, a second opinion or more information.

Providers, see how to refer a patient.