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Causes of heart failure in infants and children

Ventricular dysfunction

Structurally normal heart

Cardiomyopathy

Dilated

Hypertrophic (rarely causes HF, except with so called "burnt-out" HCM)

Restrictive

Noncompaction

Arrhythmogenic right ventricular cardiomyopathy

Myocarditis 

Myocardial infarction/ischemia

Anomalous left coronary artery arising off the pulmonary artery (ALCAPA)

Kawasaki disease with coronary artery aneurysm

Coronary vasculitis

Premature atherosclerotic coronary artery disease (very rare in children; may occur in
patients with rare genetic lipid disorders [eg, homozygous familial hypercholesterolemia])

Arrhythmogenic

Complete heart block with bradycardia

Supraventricular tachycardia

Ventricular tachycardia

Drug/toxin exposure

 Anthracycline

Noncardiac causes

Sepsis

Renal failure
 Respiratory disorders (eg, obstructive sleep apnea, bronchopulmonary dysplasia, cystic
fibrosis, interstitial lung disease)

HIV infection

Systemic lupus erythematosus

Congenital heart disease

Complex congenital heart defect with concurrent ventricular dysfunction

Complex congenital heart defect, surgically corrected with late ventricular dysfunction ("burnt-
out" congenital heart disease)

Preserved ventricular contractility

Volume overload

Left-to-right shunting

Ventricular septal defect

Patent ductus arteriosus

Atrial septal defect (rare)

Aortopulmonary window

Atrioventricular septal defect

Single ventricle physiology with unobstructed pulmonary blood flow

Valvular insufficiency

Aortic regurgitation

Mitral regurgitation

Pulmonary regurgitation

Noncardiac causes

Arteriovenous malformation

Fluid overload

Pressure overload

Left-sided

Aortic stenosis

Aortic coarctation

Systemic hypertension

Right-sided

Pulmonary stenosis

Pulmonary hypertension
HF: heart failure; HCM: hypertrophic cardiomyopathy.

Adapted from: Hsu DT, Pearson GD. Heart failure in children: part I: history, etiology, and pathophysiology. Circ Heart Fail
2009; 2:65.

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