Aetiology
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7227.104 (Published 08 January 2000) Cite this as: BMJ 2000;320:104
- G Y H Lip,
- C R Gibbs,
- D G Beevers
The relative importance of aetiological factors in heart failure is dependent on the nature of the population being studied, as coronary artery disease and hypertension are common causes of heart failure in Western countries, whereas valvar heart disease and nutritional cardiac disease are more common in the developing world. Epidemiological studies are also dependent on the clinical criteria and relevant investigations used for diagnosis, as it remains difficult, for example, to distinguish whether hypertension is the primary cause of heart failure or whether there is also underlying coronary artery disease.
Causes of heart failure
Coronary artery disease
Myocardial infarction
Ischaemia
Hypertension
Cardiomyopathy
Dilated (congestive)
Hypertrophic/obstructive
Restrictive—for example, amyloidosis, sarcoidosis, haemochromatosis
Obliterative
Valvar and congenital heart disease
Mitral valve disease
Aortic valve disease
Atrial septal defect, ventricular septal defect
Arrhythmias
Tachycardia
Bradycardia (complete heart block, the sick sinus syndrome)
Loss of atrial transport—for example, atrial fibrillation
Alcohol and drugs
Alcohol
Cardiac depressant drugs (β blockers, calcium antagonists)
“High output” failure
Anaemia, thyrotoxicosis, arteriovenous fistulae, Paget's disease
Pericardial disease
Constrictive pericarditis
Pericardial effusion
Primary right heart failure
Pulmonary hypertension—for example, pulmonary embolism, cor pulmonale
Tricuspid incompetence
Coronary artery disease and its risk factors
Coronary heart disease is the commonest cause of heart failure in Western countries. In the studies of left ventricular dysfunction (SOLVD) coronary artery disease accounted for almost 75% of the cases of chronic heart failure in male white patients, although in the Framingham heart study, coronary heart disease accounted for only 46% of cases of heart failure in men and 27% of chronic heart failure cases in women. Coronary artery disease and hypertension (either alone or in combination) were implicated as the cause in over 90% of cases of heart failure in the Framingham study.
Recent studies that have allocated aetiology on the basis of non-invasive investigations—such as the Hillingdon heart failure study—have identified coronary artery disease as the primary …
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