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Pediatric heart failure (HF) is an etiologically diverse disease manifesting a variety of clinical presentations. Nevertheless, in all HF syndromes, whether adult or pediatric, a unifying pathophysiologic mechanism is involved: A cardiac injury (either congenital or acquired) activates both compensatory and deleterious pathways that cause a chronic and progressive course that, if left untreated, ultimately hastens death. Indeed, pediatric HF is the most common reason that infants and children who have heart disease receive medical therapy and accounts for at least 50% of referrals for pediatric heart transplantation. (1)

HF results when cardiac output is insufficient to meet the metabolic demands of the body. Over time, decreased cardiac output leads to a cascade of compensatory responses that are aimed directly or indirectly at restoring normal perfusion to the body's organs and tissues. For most adults, HF results from diminished...

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