Abstract: 　Objective　To analyze the clinical and epidemiological characteristics of severe hand-foot-mouth disease (HFMD) complicated with heart failure in children, and to explore the risk factors of severe complications. Method　The clinical data of children with HFMD admitted from January 2014 to December 2014 were retrospectively analyzed and their HFMD was at clinical stage 2 or over. Results　There were totally 321 cases of severe HFMD, in which common group (clinical stage 2) had 306 cases and cardiopulmonary failure group (clinical stage 3 or 4) had 15 cases. There was no death in common group, while 7 cases died in cardiopulmonary failure group, and there was statistical difference (P<0.001). The median age in cardiopulmonary failure group was 9 months (6－20 months), which was lower than that in common group (median age of 24-month-old, 3 months to 12 years) and there was statistical difference (P<0.01). The peak temperature and fever duration were (39.44±0.23)℃, (5.01±0.94) d respectively in cardiopulmonary failure group, both of which were higher than peak temperature of (39.12 ±0.20)℃ and fever duration of (3.93 ± 0.47) d in common group, and the differences were significant (P all<0.05). The incidences of vomit, disturbance of consciousness, peripheral circulation, respiratory rhythm irregular and pneumonedema in cardiopulmonary failure group were higher than those in common group, and there were statistically significant differences (P all<0.001). The positive rate of human enterovirus 71 (EV71) in cardiopulmonary failure group was 85.7%, which was higher than that in common group, and there was significant difference (P<0.01). The levels of N terminal brain natriuretic peptide (NT-pro BNP) in cardiopulmonary failure group were all increased (100%), the rate of which was higher than that in common group (35.3%), and there was significant difference (P<0.001). Conclusion For children with HFMD, vomiting, consciousness disorders, circulatory disorders, respiratory rhythm disorders, EV71 positive and elevated levels of NT-pro BNP were risk factors of cardiopulmonary failure, and disease changes should be closely monitored.