Causes and Risks

Heart Failure

Causes & Risk Factors

Heart failure has many causes and can evolve in different ways. It can be a direct, last-stage result of heart damage from one or more of several heart or circulation diseases. It can occur over time as the heart tries to compensate for abnormalities caused by these conditions, a condition called remodeling.

In all cases, the weaker pumping action of the heart means that less blood is sent to the kidneys. The kidneys respond by retaining water and salt. This in turn increases edema (fluid build-up) in the body, which causes widespread damage.

The most common causes of heart failure are hypertension (high blood pressure) and coronary artery disease. Here's more information on these and other common causes of heart failure:

  • High Blood Pressure: Uncontrolled high blood pressure, or hypertension, can cause a heart attack but it is also a major cause of heart failure even in the absence of an attack. In fact, about 75 percent of cases of heart failure start with hypertension.

  • Coronary Artery Disease: Coronary artery disease is the end result of a complex process called atherosclerosis (commonly called "hardening of the arteries"). It is the most common cause of heart attack and involves the buildup of unhealthy cholesterol on the arteries, with inflammation and injury in the cells of the blood vessels. The arteries narrow and become brittle and subject to damage. Heart failure in such cases most often results from a localized pumping defect in the left side of the heart.

  • Damage after a Heart Attack: People now often survive heart attacks, but eventually many develop heart failure from the physical damage done to the heart muscles by the attack. So ironically, heart attack recovery is probably one of the major factors in the dramatic increase in heart failure cases over the past decade.

  • Valvular Heart Disease: The valves of the heart control the flow of blood leaving and entering the heart. Abnormalities can lead to heart failure. In the past, rheumatic fever, which scars the heart valves and prevents them from closing, was a major cause of death from heart failure. Fortunately, antibiotics have relegated this disease to a minor cause of heart failure. Birth defects may also cause abnormal valvular development.

  • Myocarditis: Inflammation of the heart muscle may occur because of viral infections or other causes. Often the cause is unknown. This can lead to poor heart function. These may improve with time, but the outcome is variable.

Other risk factors include:

  • Congenital heart diseases
  • Cardiac arrhythmias, or irregular heartbeats
  • Diabetes
  • Obesity
  • Family history of heart failure
  • Excess alcohol consumption
  • A diet high in salt

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This page was last updated: September 15, 2014

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