Medicine Medicine · Cardiology · High Yield

Heart Failure Causes

Heart failure affects 2% of the population. Identifying and treating the underlying cause is the cornerstone of management — alongside pharmacological optimisation and device therapy.

✦ The Mnemonic

"CHAMP Causes Heart Failure"

Coronary · Hypertension · Arrhythmia · Myocarditis/cardiomyopathy · Pressure/valvular

C Coronary artery disease Most common cause; ischaemia → systolic dysfunction; post-MI remodelling

H Hypertension Pressure overload → LV hypertrophy → diastolic dysfunction → eventual systolic failure

A Arrhythmia AF (most common arrhythmia in HF), tachycardia-induced cardiomyopathy, heart block

M Myocarditis / Cardiomyopathy Dilated (most common; often idiopathic/viral); hypertrophic (HCM); restrictive (amyloid, sarcoid)

P Pressure/valvular disease Aortic stenosis, mitral regurgitation; alcohol; drugs (anthracyclines, trastuzumab)

📚 Clinical Breakdown

HFrEF (heart failure with reduced ejection fraction, EF <40%): systolic dysfunction — weak contraction. Treat with: ACEi/ARB, beta-blocker, mineralocorticoid receptor antagonist (MRA), SGLT2 inhibitor — the 'fantastic four' of modern HFrEF therapy. Each drug class reduces mortality independently.

HFpEF (heart failure with preserved ejection fraction, EF >50%): diastolic dysfunction — stiff ventricle, normal contraction. More common in elderly women with hypertension and atrial fibrillation. Diagnosis requires evidence of elevated filling pressures (echo, natriuretic peptides). Management: diuretics for symptoms; SGLT2 inhibitors reduce hospitalisation.

Natriuretic peptides: BNP and NT-proBNP are released from ventricular myocardium in response to wall stress. They are excellent for ruling OUT heart failure (high NPV) — an NT-proBNP <125 pg/mL makes heart failure very unlikely. They also guide prognosis and monitoring of treatment response.

Most common cause Coronary artery disease

HFrEF EF <40%; systolic failure

HFpEF EF >50%; diastolic failure

'Fantastic four' drugs ACEi, beta-blocker, MRA, SGLT2i

⭐ Clinical Pearl

SGLT2 inhibitors (dapagliflozin, empagliflozin) have revolutionised heart failure treatment — they reduce hospitalisation and mortality in both HFrEF and HFpEF. Originally developed as antidiabetics, their cardiac benefit appears largely independent of glucose lowering. They are now recommended in all stable HFrEF patients regardless of diabetes status.

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