In summary, the mechanisms of heart failure in children
and the elderly are similar to those in adults. However, the
causes and manifestations may differ because of age. In children,
CHF is seen most commonly during infancy and immediately
after heart surgery. It can be caused by congenital and
acquired heart defects and is characterized by fatigue, effort
intolerance, cough, anorexia, abdominal pain, and impaired
growth. Treatment of CHF in children includes correction of
the underlying cause when possible. For congenital anomalies
that are amenable to surgery, medical treatment often is
needed for a time before surgery and usually is continued in
the immediate postoperative period. For many children,
only medical management can be provided.
In the elderly, age-related changes in cardiovascular functioning
contribute to CHF but are not in themselves sufficient
to cause heart failure. The manifestations of congestive failure
often are different and superimposed on other disease conditions;
therefore, CHF often is more difficult to diagnose in the
elderly than in younger persons. Because the elderly are more
susceptible to adverse drug reactions and have more problems
with compliance, the number of drugs that are prescribed is
kept to a minimum, and the drug regimen is kept as simple
as possible.