As noted previously, IHD is the most common cause of CHF. Cumulative injury to the ventricular myocardium from ischemia and infarction can lead to impaired ventricular systolic and diastolic function and, ultimately, pump failure. Additional causes of systolic dysfunction include
valvular heart disease (aortic stenosis and aortic or mitral regurgitation)
cardiomyopathies (idiopathic, metabolic, infectious, toxic, or connective tissue disease)
myocarditis (secondary to viral or inflammatory diseases)
infiltrative diseases (amyloidosis, sarcoidosis, and metastatic disease)
left ventricular hypertrophy
Right- and left-sided heart failure often occur simultaneously in the common causes of CHF—namely, IHD, valvular disease, and the congestive cardiomyopathies. The causes of HFpEF include severe anemia, hyperthyroidism, arteriovenous fistulas, beriberi, and Paget disease.
In HFpEF, the demand for oxygen is so great that the heart eventually fails because it cannot maintain the excessive cardiac output indefinitely. In some patients, heart failure may be more complex; for example, CHF may develop in a patient with IHD who has become severely anemic. Pure right ventricular failure may result from chronic obstructive pulmonary disease, pulmonary hypertension, tricuspid or pulmonary valve disease, right ventricular infarction, or constrictive pericarditis.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.