Causes of heart failure:

1. Diabetes.
2. Obesity.
3. Smoking.
4. Hypertension (High Blood Pressure).
5. Heart attack.
6. Depression.
7. Inherited heart disease.
8. Congenital heart defects.
9. Anaemia.
10. Sleep disorders.
11. Hyperthyroidism.
12. Hypothyroidism.
13. Faulty heart valves.
14. Myocarditis.
15. Heart arrhythmias.
16. Emphysema.
17. Lupus.
18. Haemochromatosis

Causes of heart failure in children:

1. Rheumatic fever
2. Acute hypertension (glomerulonephritis).
3. Viral myocarditis.
4. Endocarditis.
5. Severe anemia.
6. Haemochromatosis-haemosiderosis.
7. Cor-pulmonale (from cystic fibrosis)
8. Cardiomyopathy (hypertrophic dilated).

Causes of heart failure in infant- Toddler : 

1. Left to right cardiac shunts (VSD).
2. Left sided obstructive lesions (coarctation of aorta, hypoplastic left side of the heart).
3. Large mixing cardiac defects (single ventricle, truncus arteriosus).
4. Viral myocarditis.

Clinical features of heart failure:

Infants:  Nonspecific e.g irritability, excessive sweating, poor feeding and difficult feeding, respiratory distress.

Older children:  Effort intolerance, dysponea on exertion, excessive sweating, cough, abdominal pain

Physical examination of Heart failure:

General Physical examination:

• Tachyponea
• Tachycardia
• Cold peripheries
• Weak thredy pulse
• Low blood pressure
• Prolong capillary refill time
• Raised JVP
• Dependant oedema
• Cyanosis

Chest examination:

• Cardiomegaly 
• Gallop rhythmm
• Murmurs
• Wheeze
• Basal crepitation

Others features:

• Tender hepatomegaly.
• Positive hepatojugular reflux.

Investigations of Heart failure:

1. X-ray chest: Cardiomegaly, pulmonary vascular congestion
2. ECG: Not helpful.
3. Echocardiography: Demonstrate structural pathology.
4. Blood gas analysis: Arterial oxygen level may be decreased.
5. CBC : May show low Hb

Treatment of Heart failure:

1. Decrease physical activity: Propped up position.
2. Oxygen inhalation.
3. Diet: Salt and fluid should be restricted. Adequate calorie intake should be ensured.
4. Diuretics: Frusemide, spironolactone and their combination.
5. Digitalis (digoxin); routine, rapid and slow digitalization.
6. Afterload reducing agents (vasodilator drugs); captopril, enalapril
7. Inotropic agents (other than digitalis):

a.  B-adrenergic agonists: Isoproterenol, dopamine, dobutamine

b. Phosphodiesterase  inhibitors: Amrinone.

   8. Treatment of underlying cause.

Causes of heart failure in infant- Toddler : 

Left to right cardiac shunts (VSD).

Left sided obstructive lesions (coarctation of aorta, hypoplastic left side of the heart).

Large mixing cardiac defects (single ventricle, truncus arteriosus).

Viral myocarditis.

causes of cardiomegaly

1. Congestive cardiac failure.
2. Dilated cardiomyopathy
3. Multiple valvular heart disease.
4. Myocarditis.
5. Hyperdynamic circulation, e.g in severe anaemia, thyrotoxicosis, pregnancy, arterio-venous fistula, vitamin B1 deficiency (beriberi) etc.
6. Shunt anomaly eg ASD, VSD, PDA