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Heart failure can develop either because of conditions that damage and weaken the heart (this increases the size of its cavities and means it cannot pump enough blood to the rest of the body) or because it loses elasticity and its cavities are unable to fill correctly.
Whatever the cause, the end result is the heart cannot meet the rest of the body’s demands for blood.
The main factors that can damage the heart and produce cardiac insufficiency are:
Coronary artery disease (ischaemic cardiomyopathy). This is the most common form of heart disease and the main cause of heart failure. The coronary arteries supply the heart with oxygenated blood, without which it could not function. Ageing, and the simultaneous appearance of one or more predisposing factors, progressively produces chronic inflammation of the arteries which become harder and accumulate cholesterol plaques (atheromatous plaques) on their walls; this process is known as arteriosclerosis. As the plaques grow, the internal diameter of the coronary arteries is reduced to such a degree that it eventually decreases the blood flow and prevents the heart from working properly. Occasionally, when a plaque ruptures, blood flow becomes completely obstructed and it causes an acute myocardial infarction (heart attack).
High blood pressure. Blood pressure is the force blood exerts against artery walls due to the heart’s pumping action. Without this pressure blood would not circulate. When arteries lose some of their elasticity it increases blood pressure. When blood pressure is higher than normal the heart must pump with more force to ensure blood circulates throughout the body. If this situation is sustained over time, then the heart increases in size and loses the elasticity it requires to generate enough force. A more rigid heart can eventually lose its capacity to store the volume of blood it must pump around the body in each heartbeat.
Valvular heart disease. Heart valves ensure blood flows in the correct direction. Valve damage, whether due to insufficient blood flow (coronary ischaemia), an infection or an anatomical heart defect, forces the heart to work more intensely to keep blood flowing in the correct direction. This overstrain weakens the heart’s force of contraction.
Direct damage to the heart muscle (cardiomyopathy). There are many factors that can cause direct damage to the heart itself, including infections, alcohol abuse, certain recreational drugs, e.g., cocaine, some medicines, and chemotherapy. Some cardiomyopathies are also associated with genetic factors.
Inflammation of the heart muscle (myocarditis). The majority of cases of myocarditis are caused by viruses and can lead to ventricular failure (it can affect either of the ventricles).
Congenital disorders. Congenital heart defects are a result of abnormal heart development while foetuses are still in the womb.
Heart rhythm disorders (arrhythmias). Arrhythmias can be caused by an increased heart rhythm (tachycardia), reduced heart rhythm (bradycardia) or the appearance of extra beats during the normal rhythm (extrasystoles).
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Substantiated information by:
Evelyn Santiago VacasCardiologistCardiology Department
Felix Pérez VillaCardiologistCardiology Department
Josefina Casal RodríguezNurseCardiology Department
Published: 20 February 2018
Updated: 20 February 2018
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