Causes of heart failure

Heart failure is caused by conditions that weaken or damage your heart muscle. Six out of every seven patients hospitalized with CHF have a history of coronary artery disease (i.e., heart attacks); three out of four have hypertension, or high blood pressure, and more than half have defective heart valves or a history of diabetes. A heart attack does its damage by suddenly shutting off blood flow to part of the heart muscle. Hypertension, defective heart valves, and diabetes all make the heart work too hard, causing damage over time. A weakened heart, often referred to as cardiomyopathy, also can be inherited or the result of an infection, thyroid disease, and alcohol or drug abuse. Further, the condition can be idiopathic, meaning the cause is unknown.

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"Heart failure" encompasses systolic heart failure (SHF) and diastolic heart failure (DHF). Systolic heart failure (or systolic cardiac dysfunction) occurs when the heart muscle contracts with too little force, causing less oxygen-rich blood to be pumped through the body.

Diastolic heart failure (DHF or diastolic dysfunction) occurs when the heart contracts normally but the ventricle walls don't relax enough to let the chamber fill, as it should, and the heart has less blood to pump out. Unlike systolic heart failure, diastolic heart failure occurs more often in women. The mortality rate of DHF is half that of patients with SHF, yet DHF causes as many hospitalizations as SHF. While guidelines for diagnosing and treating SHF have been widely published, little attention has been paid to constructing similar guidelines for DHF.

A test called ejection fraction, which measures the amount of blood in the left ventricle that is pumped out when the chamber contracts, can help determine if systolic or diastolic heart failure is present. A normal ejection fraction is over 50 percent. An ejection fraction of less than 40 percent usually confirms systolic heart failure. Patients with diastolic heart failure, by contrast, can have a normal ejection fraction.