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Heart failure in the young
  1. Michael Burch
  1. Correspondence to:
    Dr Michael Burch, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK;

Statistics from

Heart failure is an enormous clinical burden in adult medicine, largely because of the prevalence of atheromatous coronary disease. In children, where coronary disease is not the leading cause of heart failure, it is less common. It is, however, an important disease, accounting for 10% of paediatric cardiac transplants in children.

Cardiac symptoms in children are usually the result of congenital lesions. Most of these lesions, such as septal defects, are amenable to surgical intervention. It is not appropriate to expand on the management of congenital heart lesions in this review. There is a small subgroup of children that have diastolic failure from cardiomyopathic restriction to flow.

The remaining patients, which will be focused on below, have heart failure that is principally related to poor myocardial function and largely comprise those children with dilated poorly contracting ventricles, which can be related to specific aetiologies in some cases. Particular topics of debate in paediatric heart failure concern:

  • the diagnosis and management of myocarditis versus dilated cardiomyopathy

  • the most appropriate investigations for new onset heart failure

  • cellular responses to heart failure

  • the increasing population of anthracycline treated survivors of childhood malignant disease

  • treatment strategies.


Indications for transplantation are a guide to the spectrum of causes of severe heart failure. Dilated cardiomyopathy remains the principal indication for cardiac transplantation in children worldwide throughout childhood, apart from infancy when congenital heart disease is a more common indication. The prognosis for dilated cardiomyopathy is around 60% at five years from presentation (fig 1), with a high attrition within six months of presentation.1

Figure 1

Survival curve (blue line) from presentation of 63 children with dilated cardiomyopathy, with 95% confidence intervals (red and green lines). Reproduced from Burch et al1 with permission from the BMJ Publishing Group.

The genetics of dilated cardiomyopathy have been described as …

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Supplementary materials

  • Heart failure in the young
    Michael Burch
    Heart 2002; 88: 198-202.

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