Congestive heart failure – the breathless baby

  • Heart failure is a syndrome caused when the heart is unable to supply blood to meet tissue demands. In the context of CHD, heart failure is caused by shunting of blood from left→ right.
  • As oxygenated blood has a higher pressure, when it is shunted to the right side of the heart, there is increased flow through the pulmonary vasculature.
  • This congestion results in pulmonary oedema and breathlessness.
  • As the total volume being pumped into the systemic circulation is lower, this also results in poor tissue perfusion which causes fatigue, poor nutrition and failure to thrive.

Learning bite

Congestive cardiac failure as a result of CHD often presents in the first 1-3 months of life. This is because pulmonary blood flow is initially restricted by high pulmonary vascular resistance which starts to decline after birth which leads to increased shunting.

Clinical features of CHD in newborns/infants

The presentation of CCF in neonates is extremely different to the presentation in adults. Symptoms and signs of reduced cardiac output and reduced tissue perfusion may often be non-specific.

Presentation Symptoms Signs Potential Cardiac Lesions
CCF  (Breathless baby)

Feeding difficulty

Sweating/tachypnoea with feeds

Failure to thrive

Respiratory distress


Tachypnoea and laboured breathing



Cyanosis if severe

Faltering growth

Displaced apex beat

Cool peripheries

Gallop rhythm



PDA if large