[Congestive heart failure in infancy and childhood]

Congestive heart failure is the inability of the heart to provide a sufficient output at a sufficient arterial pressure for the metabolic needs of the organism. Having presented the physiologic mechanisms of the contraction of the heart and its regulatory mechanisms the different aspects of classification of heart failure and its neurohormonal modulation are described. The epidemiology of heart failure in childhood is largely unknown, the causes vary considerably, symptoms are age-dependent. Main diagnostic tools for etiologic clarification are echocardiography and chest-x-ray. Focus of therapy is to eliminate the causes, but general recommendations may not be forgotten. Medical treatment of acute severe heart failure is use of catecholamines, ino- and vasodilators in the intensive care unit. Therapy of chronic heart failure is performed with diuretics, digitalis and ACE-inhibitors. Their pharmacologic effect, therapeutic trials in adults and children and peculiarities of pharmacology and side effects in childhood are reported. Low dose beta-blockers are a new therapeutic strategy still not established in children.