Heart failure in children and adolescents: an update on diagnostic approaches and management.

Cardiac failure is a clinical syndrome that may develop in children due to cardiac dysfunction or underlying structural heart diseases. Considering the differences in the diagnostic and therapeutic approaches of pediatric heart failure (PHF) and adult HF, we aimed to review the current literature on PHF. Relevant studies were extracted from Medline/PubMed, Google Scholar, and Clinical Trial Registries using the terms "Paediatric heart failure" or "heart failure in children" and "management" or "decongestive therapy". Recent advances in diagnostic approaches such as cardiac magnetic resonance, speckle-tracking echocardiography, tissue Doppler imaging, and molecular diagnostic techniques have increased our understanding of PHF. It is imperative to evaluate miscellaneous interrelated factors responsible for the development of PHF including myocardial function, pulmonary and systemic blood flow, heart rhythm, valve function, and nutrition. Although the recent advances show established results of many new drugs in adult HF trials, conclusions cannot be drawn that these drugs will show similar efficacy in children considering the heterogeneous nature of underlying mechanisms and variable pharmacodynamics and pharmacokinetics. Therefore, the underlying pathophysiology of PHF and the mechanism of action of different drugs should be considered to choose an appropriate therapy. Further trials are needed to establish these drugs' efficacy and safety, and a combined multidisciplinary strategy will help enhance the outcome of PHF.