Chronic Heart Failure
The predominance of causes of heart failure are difficult to analyze due to challenges in diagnosis, differences in populations, and changing prevalence of causes with age.
A 19 year study of 13000 healthy adults in the United States (the National Health and Nutrition Examination Survey (NHANES I) found the following causes ranked by Population Attributable Risk score:
- Ischaemic Heart Disease 62%
- Cigarette Smoking 16%
- Hypertension (high blood pressure)10%
- Obesity 8%
- Diabetes 3%
- Valvular heart disease 2% (much higher in older populations)
An Italian registry of over 6200 patients with heart failure showed the following underlying causes:
- Ischaemic Heart Disease 40%
- Dilated Cardiomyopathy 32%
- Valvular Heart Disease 12%
- Hypertension 11%
- Other 5%
Rarer causes of heart failure include:
- Viral Myocarditis (an infection of the heart muscle)
- Infiltrations of the muscle such as amyloidosis
- HIV cardiomyopathy (caused by Human Immunodeficiency Virus)
- Connective Tissue Diseases such as Systemic lupus erythematosus
- Abuse of drugs such as alcohol
- Pharmaceutical drugs such as chemotherapeutic agents.
Obstructive Sleep Apnea a condition of sleep disordered breathing overlaps with obesity, hypertension and diabetes and is regarded as an independent cause of heart failure.
Acute decompensated heart failure
Chronic stable heart failure may easily decompensate. This most commonly results from an intercurrent illness (such as pneumonia), myocardial infarction (a heart attack), arrhythmias, uncontrolled hypertension, or a patient's failure to maintain a fluid restriction, diet or medication. Other well recognised precipitating factors include anaemia and hyperthyroidism which place additional strain on the heart muscle. Excessive fluid or salt intake, and medication that causes fluid retention such as NSAIDs and thiazolidinediones, may also precipitate decompensation.
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