Editing Heart failure (section)

==Causes==
Since heart failure is a [[syndrome]] and not a disease, establishing the underlying cause is vital to diagnosis and treatment.{{sfn|Ponikowski|Voors|Anker|Bueno|2016|p=2136}}<ref name="IQWiG2018">{{Cite book |url=https://www.ncbi.nlm.nih.gov/books/NBK481485/ |title=Types of heart failure |date=2018-01-25 |publisher=Institute for Quality and Efficiency in Health Care (IQWiG) |via=National Center for Biotechnology Information, U.S. National Library of Medicine |language=en |access-date=9 August 2021 |archive-date=20 February 2021 |archive-url=https://web.archive.org/web/20210220140029/https://www.ncbi.nlm.nih.gov/books/NBK481485/ |url-status=live }}</ref> In heart failure, the structure or the function of the heart or in some cases both are altered.<ref name="ESC2021"/>{{rp|page=3612}} Heart failure is the potential end stage of all heart diseases.<ref name="Davis_2000">{{cite journal | vauthors = Davis RC, Hobbs FD, Lip GY | title = ABC of heart failure. History and epidemiology | journal = BMJ | volume = 320 | issue = 7226 | pages = 39–42 | date = January 2000 | pmid = 10617530 | pmc = 1117316 | doi = 10.1136/bmj.320.7226.39 }}</ref>

Common causes of heart failure include [[coronary artery disease]], including a previous [[myocardial infarction]] (heart attack), [[hypertension|high blood pressure]], [[atrial fibrillation]], [[valvular heart disease]], [[alcohol use disorder|excess alcohol use]], [[infection]], and [[cardiomyopathy]] of an unknown cause.<ref name=Lancet2005>{{cite journal | vauthors = McMurray JJ, Pfeffer MA | title = Heart failure | journal = Lancet | volume = 365 | issue = 9474 | pages = 1877–89 | year = 2005 | pmid = 15924986 | doi = 10.1016/S0140-6736(05)66621-4 | s2cid = 38678826 }}</ref><ref name="AHA2022"/>{{rp|page=e279}}<ref name="ESC2021"/>{{rp|at=Table 5}} In addition, viral infection and subsequent inflammation of the heart's myocardial tissue (termed [[myocarditis]]) can similarly contribute to the development of heart failure. Genetic predisposition plays an important role. If more than one cause is present, progression is more likely and prognosis is worse.<ref>{{cite journal | vauthors = Hazebroek MR, Moors S, Dennert R, van den Wijngaard A, Krapels I, Hoos M, Verdonschot J, Merken JJ, de Vries B, Wolffs PF, Crijns HJ, Brunner-La Rocca HP, Heymans S | title = Prognostic Relevance of Gene-Environment Interactions in Patients With Dilated Cardiomyopathy: Applying the MOGE(S) Classification | journal = Journal of the American College of Cardiology | volume = 66 | issue = 12 | pages = 1313–23 | date = September 2015 | pmid = 26383716 | doi = 10.1016/j.jacc.2015.07.023 | doi-access = free }}</ref>

[[Cardiomyopathy|Heart damage]] can predispose a person to develop heart failure later in life and has many causes including systemic viral infections (e.g., [[HIV/AIDS|HIV]]), [[chemotherapeutic agent]]s such as [[daunorubicin]], [[cyclophosphamide]], [[trastuzumab]] and [[substance use disorder]]s of substances such as [[alcoholic beverage|alcohol]], [[cocaine]], and [[methamphetamine]]. An uncommon cause is exposure to certain toxins such as [[lead]] and [[cobalt]]. Additionally, infiltrative disorders such as [[amyloidosis]] and [[connective tissue disease]]s such as [[systemic lupus erythematosus]] have similar consequences. [[Obstructive sleep apnea]] (a condition of sleep wherein disordered breathing overlaps with obesity, hypertension, and/or diabetes) is regarded as an independent cause of heart failure.<ref>{{cite journal | vauthors = Khattak HK, Hayat F, Pamboukian SV, Hahn HS, Schwartz BP, Stein PK | title = Obstructive Sleep Apnea in Heart Failure: Review of Prevalence, Treatment with Continuous Positive Airway Pressure, and Prognosis | journal = Texas Heart Institute Journal | volume = 45 | issue = 3 | pages = 151–161 | date = June 2018 | pmid = 30072851 | pmc = 6059510 | doi = 10.14503/THIJ-15-5678 | doi-access = free }}</ref> Recent reports from [[clinical trial]]s have also linked variation in blood pressure to heart failure<ref>{{cite journal | vauthors = Muntner P, Whittle J, Lynch AI, Colantonio LD, Simpson LM, Einhorn PT, Levitan EB, Whelton PK, Cushman WC, Louis GT, Davis BR, Oparil S | title = Visit-to-Visit Variability of Blood Pressure and Coronary Heart Disease, Stroke, Heart Failure, and Mortality: A Cohort Study | journal = Annals of Internal Medicine | volume = 163 | issue = 5 | pages = 329–38 | date = September 2015 | pmid = 26215765 | pmc = 5021508 | doi = 10.7326/M14-2803 }}</ref><ref>{{cite journal | vauthors = Nuyujukian DS, Koska J, Bahn G, Reaven PD, Zhou JJ | title = Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT | journal = Diabetes Care | volume = 43 | issue = 7 | pages = 1471–1478 | date = July 2020 | pmid = 32327422 | pmc = 7305004 | doi = 10.2337/dc19-2540 | hdl-access = free | hdl = 10150/641980 }}</ref> and cardiac changes that may give rise to heart failure.<ref>{{cite journal | vauthors = Nwabuo CC, Yano Y, Moreira HT, Appiah D, Vasconcellos HD, Aghaji QN, Viera A, Rana JS, Shah RV, Murthy VL, Allen NB, Schreiner PJ, Lloyd-Jones DM, Lima JA | title = Association Between Visit-to-Visit Blood Pressure Variability in Early Adulthood and Myocardial Structure and Function in Later Life | journal = JAMA Cardiology | volume = 5 | issue = 7 | pages = 795–801 | date = July 2020 | pmid = 32293640 | pmc = 7160747 | doi = 10.1001/jamacardio.2020.0799 }}</ref>

===High-output heart failure===
[[High-output heart failure]] happens when the amount of blood pumped out is more than typical and the heart cannot keep up.<ref name="ReferenceA"/> This can occur in [[Volume overload|overload]] situations such as blood or serum infusions, kidney diseases, chronic severe [[anemia]], [[beriberi]] (vitamin B<sub>1</sub>/[[thiamine]] deficiency), [[hyperthyroidism]], [[cirrhosis]], [[Paget's disease of bone|Paget's disease]], [[multiple myeloma]], [[arteriovenous fistula]]e, or [[arteriovenous malformation]]s.<ref name="pmid26567494">{{cite journal |vauthors=McCulloch B |title=High-Output Heart Failure Caused by Thyrotoxicosis and Beriberi |journal=Crit Care Nurs Clin North Am |volume=27 |issue=4 |pages=499–510 |date=December 2015 |pmid=26567494 |doi=10.1016/j.cnc.2015.07.004 |url=}}</ref><ref name="Carlisi">{{cite journal |vauthors=Carlisi M, Mancuso S, Lo Presti R, Siragusa S, Caimi G |title=High Output Heart Failure in Multiple Myeloma: Pathogenetic Considerations |journal=Cancers (Basel) |volume=14 |issue=3 |date=January 2022 |page=610 |pmid=35158878 |pmc=8833382 |doi=10.3390/cancers14030610 |url=|doi-access=free }}</ref>

===Acute decompensation===
{{main|Acute decompensated heart failure}}
[[File:Kerley-B-Linien.jpg|thumb|[[Kerley B lines]] in [[radiograph]] of acute cardiac decompensation. The short, horizontal lines can be found everywhere in the [[right lung]].]]
Chronic stable heart failure may easily [[Decompensation|decompensate]] (fail to meet the body's metabolic needs). This most commonly results from a concurrent illness (such as [[myocardial infarction]] (a heart attack) or [[pneumonia]]), [[cardiac arrhythmia|abnormal heart rhythms]], uncontrolled [[hypertension]], or a person's failure to maintain a fluid restriction, diet, or medication.<ref name="OPTIMIZE-HF">{{cite journal | vauthors = Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, O'Connor CM, Pieper K, Sun JL, Yancy CW, Young JB | title = Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF | journal = Archives of Internal Medicine | volume = 168 | issue = 8 | pages = 847–54 | date = April 2008 | pmid = 18443260 | doi = 10.1001/archinte.168.8.847 | doi-access =  | s2cid = 20912905 }}</ref>

Other factors that may worsen CHF include: anemia, hyperthyroidism, excessive fluid or salt intake, and medication such as [[Non-steroidal anti-inflammatory drug|NSAIDs]] and [[thiazolidinedione]]s.<ref>{{cite journal | vauthors = Nieminen MS, Böhm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, Hasin Y, Lopez-Sendon J, Mebazaa A, Metra M, Rhodes A, Swedberg K, Priori SG, Garcia MA, Blanc JJ, Budaj A, Cowie MR, Dean V, Deckers J, Burgos EF, Lekakis J, Lindahl B, Mazzotta G, Morais J, Oto A, Smiseth OA, Garcia MA, Dickstein K, Albuquerque A, Conthe P, Crespo-Leiro M, Ferrari R, Follath F, Gavazzi A, Janssens U, Komajda M, Morais J, Moreno R, Singer M, Singh S, Tendera M, Thygesen K | title = Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology | journal = European Heart Journal | volume = 26 | issue = 4 | pages = 384–416 | date = February 2005 | pmid = 15681577 | doi = 10.1093/eurheartj/ehi044 | url = http://repositorio.chporto.pt/bitstream/10400.16/493/1/pdf.4.pdf | doi-access = free | access-date = 18 September 2019 | archive-date = 10 August 2017 | archive-url = https://web.archive.org/web/20170810020623/http://repositorio.chporto.pt/bitstream/10400.16/493/1/pdf.4.pdf | url-status = live }}</ref> NSAIDs increase the risk twofold.<ref>{{cite journal | vauthors = Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, Bombardier C, Cannon C, Farkouh ME, FitzGerald GA, Goss P, Halls H, Hawk E, Hawkey C, Hennekens C, Hochberg M, Holland LE, Kearney PM, Laine L, Lanas A, Lance P, Laupacis A, Oates J, Patrono C, Schnitzer TJ, Solomon S, Tugwell P, Wilson K, Wittes J, Baigent C | title = Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials | journal = Lancet | volume = 382 | issue = 9894 | pages = 769–79 | date = August 2013 | pmid = 23726390 | pmc = 3778977 | doi = 10.1016/S0140-6736(13)60900-9 }}</ref>

===Medications===
A number of medications may cause or worsen the disease. This includes [[nonsteroidal anti-inflammatory drug|NSAIDs]], [[COX-2 inhibitor]]s, a number of [[anesthetic]] agents such as [[ketamine]], thiazolidinediones, some [[Cancer#Medication|cancer medications]], several [[antiarrhythmic agent|antiarrhythmic medications]], [[pregabalin]], [[alpha-2 adrenergic receptor agonist]]s, [[minoxidil]], [[itraconazole]], [[cilostazol]], [[anagrelide]], [[stimulant]]s (e.g., [[methylphenidate]]), [[tricyclic antidepressant]]s, [[lithium (medication)|lithium]], [[antipsychotic]]s, [[dopamine agonist]]s, [[TNF inhibitor]]s, [[calcium channel blocker]]s (especially [[verapamil]] and [[diltiazem]]<ref name="pmid30165516">{{cite journal |vauthors=Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, etal | title=2018 ESC/ESH Guidelines for the management of arterial hypertension. | journal=Eur Heart J | year= 2018 | volume= 39 | issue= 33 | pages= 3021–3104 | pmid=30165516 | doi=10.1093/eurheartj/ehy339 | pmc= | doi-access=free }}</ref><ref name="pmid31668726">{{cite journal |vauthors=Suchard MA, Schuemie MJ, Krumholz HM, You SC, Chen R, Pratt N, etal | title=Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis. | journal=Lancet | year= 2019 | volume= 394 | issue= 10211 | pages= 1816–1826 | pmid=31668726 | doi=10.1016/S0140-6736(19)32317-7 | pmc=6924620 }}</ref>), [[salbutamol]], and [[tamsulosin]].<ref name="PageAHA">{{cite journal | vauthors = Page RL, O'Bryant CL, Cheng D, Dow TJ, Ky B, Stein CM, Spencer AP, Trupp RJ, Lindenfeld J | title = Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association | journal = Circulation | volume = 134 | issue = 6 | pages = e32–69 | date = August 2016 | pmid = 27400984 | doi = 10.1161/CIR.0000000000000426 | doi-access = free }}</ref>

By inhibiting the formation of [[prostaglandin]]s, NSAIDs may exacerbate heart failure through several mechanisms, including promotion of fluid retention, increasing [[systemic vascular resistance|blood pressure]], and decreasing a person's response to diuretic medications.<ref name="PageAHA"/> Similarly, the ACC/AHA recommends against using COX-2 inhibitor medications in people with heart failure.<ref name="PageAHA"/> Thiazolidinediones have been strongly linked to new cases of heart failure and worsening of pre-existing congestive heart failure due to their association with weight gain and fluid retention.<ref name="PageAHA"/> Certain calcium channel blockers, such as [[diltiazem]] and [[verapamil]], are known to [[Inotrope#Negative inotropic agents|decrease the force with which the heart ejects blood]], thus are not recommended in people with heart failure with a reduced ejection fraction.<ref name="PageAHA"/>

Breast cancer patients are at high risk of heart failure due to several factors.<ref>{{cite journal | vauthors = Lenneman CG, Sawyer DB | title = Cardio-Oncology: An Update on Cardiotoxicity of Cancer-Related Treatment | journal = Circulation Research | volume = 118 | issue = 6 | pages = 1008–1020 | date = March 2016 | pmid = 26987914 | doi = 10.1161/CIRCRESAHA.115.303633 }}</ref> After analyzing data from 26 studies (836,301 patients), the recent meta-analysis found that breast cancer survivors demonstrated a higher risk heart failure within first ten years after diagnosis (hazard ratio = 1.21; 95% CI: 1.1, 1.33).<ref name="Galimzhanov_2003">{{cite journal | vauthors = Galimzhanov A, Istanbuly S, Tun HN, Ozbay B, Alasnag M, Ky B, Lyon AR, Kayikcioglu M, Tenekecioglu E, Panagioti M, Kontopantelis E, Abdel-Qadir H, Mamas MA | title = Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis | journal = European Journal of Preventive Cardiology | volume = 30 | issue = 18 | pages = 2018–2031 | date = December 2023 | pmid = 37499186 | doi = 10.1093/eurjpc/zwad243 | doi-access = free }}</ref> The pooled incidence of heart failure in breast cancer survivors was 4.44 (95% CI 3.33-5.92) per 1000 person-years of follow-up.<ref name="Galimzhanov_2003"/>

===Supplements===
Certain [[alternative medicine]]s carry a risk of exacerbating existing heart failure, and are not recommended.<ref name="PageAHA"/> This includes [[Aconitum|aconite]], [[ginseng]], [[gossypol]], [[gynura]], [[licorice]], [[lily of the valley]], [[tetrandrine]], and [[yohimbine]].<ref name="PageAHA"/> Aconite can cause abnormally slow heart rates and abnormal heart rhythms such as ventricular tachycardia.<ref name="PageAHA"/> Ginseng can cause abnormally low or high blood pressure and may interfere with the effects of diuretic medications. Gossypol can increase the effects of diuretics, leading to toxicity.

Gynura can cause low blood pressure. Licorice can worsen heart failure by increasing blood pressure and promoting fluid retention.<ref name="PageAHA"/> Lily of the Valley can cause abnormally slow heart rates with mechanisms similar to those of digoxin. Tetrandrine can lower blood pressure by inhibiting [[L-type calcium channel]]s. Yohimbine can exacerbate heart failure by increasing blood pressure through alpha-2 adrenergic receptor antagonism.<ref name="PageAHA"/>