6th May 2025

Aetiology

Heart failure is commonly caused by reduced left ventricle function but can also be due to an impairment of ventricular filling. Some of the major pathogenic mechanisms leading to heart failure include ischemic myocardial damage, valvular dysfunction, pericardial or endocardial dysfunction, and disease of the great vessels. 

These dysfunctions lead to ventricular remodelling and hypertrophy to increase cardiac output, but disorganised ventricular remodelling can result in fibrosis of the myocardium and aberrant electrical pathways, increasing the risk of arrhythmias and sudden cardiac death at later stages. 

Furthermore, excessive neuro-humoral stimulation also occurs due to an ineffective blood volume and blood pressure. This stimulates both the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS). This releases antidiuretic hormone (ADH) in an attempt to increase the effective circulating volume, but ultimately increases the haemodynamic overload, resulting in further left ventricular strain, remodelling and dysfunction.