Reversible versus non-reversible causes of heart failure

In reversible causes of heart failure, cardiac function may recover partially or completely after treatment of the cause of myocardial dysfunction. Certain heart failure therapy can then possibly be tapered in stages by the treating cardiologist after some time after recovery of left ventricular (LV) function.

Reversible causes of heart failure

Ischemic heart disease (ischaemic cardiomyopathy):

Recuperation of LV function is possible after timely reperfusion in acute myocardial infarction or after revascularisation (PCI or CABG) in hibernating myocardium, if there isn’t too much persisting damage and scarring of the myocardium.

Myocarditis:

Recuperation of LV function is possible if not too much scarring of the myocardium persists after resolution of the inflammation.

Tachycardia-induced cardiomyopathy or tachycardiomyopathy.

After obtaining good control of heart rhythm, recovery of LV function occurs.

Valve disease

Aortic valve stenosis / aortic or mitral valve insufficiency.
After timely correction of valve disease, recovery of LV function may occur.

Toxic cardiomyopathy:

Abusus: alcohol, cocaine.

After complete abstinence, recovery of LV function occurs normally.

Chemotherapy:

After interruption of chemotherapy, recovery of LV function may occur under heart failure therapy.

Dilated cardiomyopathy:

Under optimal therapy (with medication and/or CRT), (partial) recovery of LV function is sometimes possible, sometimes only temporarily.

Tako-Tsubo cardiomyopathy (apical ballooning syndrome)

This is a transient dysfunction of the apical and/or mid-ventricular segments of the left ventricle, usually provoked by a psychological or physical stressor. The presentation is similar to that of acute myocardial infarction. Recovery of LV function normally occurs after 6 to 8 weeks.

Peripartum cardiomyopathy

This is a dilated cardiomyopathy with decreased LVEF that occurs at the end of pregnancy or during the first months after. Under optimal medication, recovery of LV function can occur over months, but this does not always happen.

Cardiomyopathy due to metabolic disorders

(E.g. hyper- or hypothyroidism, pheochromocytoma, Cushing's disease,...) or deficiencies (vitamin B1, selenium,...)
After treatment and correction of the underlying condition, recovery of LV function occurs.

Non-reversible causes of heart failure

Ischemic cardiomyopathy

After extensive transmural damage and scarring of the myocardium due to a major myocardial infarction, there will be no or only limited recovery of LV function.

Myocarditis:

After diffuse myocarditis, extensive scarring of the myocardium may occur and there will be no recovery of LV function. Sometimes myocarditis can remain chronic, dormant and cause progressive heart failure after years due to dilated cardiomyopathy.

Valve disease:

Aortic valve stenosis / aortic or mitral valve insufficiency.
If valve disease is corrected too late, sometimes no recovery of LV function occurs.

Toxic cardiomyopathy:

Abuse: alcohol, cocaine.

With persistent abuse, no recovery of LV function occurs.

Chemotherapy or immunotherapy

If therapy is continued or interrupted after overdose, no recovery of LV function occurs.

BWGHF

Reversible versus non-reversible causes of heart failure

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Reversible versus non-reversible causes of heart failure

Reversible causes of heart failure

Ischemic heart disease (ischaemic cardiomyopathy):

Myocarditis:

Tachycardia-induced cardiomyopathy or tachycardiomyopathy.

Valve disease

Toxic cardiomyopathy:

Dilated cardiomyopathy:

Tako-Tsubo cardiomyopathy (apical ballooning syndrome)

Peripartum cardiomyopathy

Cardiomyopathy due to metabolic disorders

Non-reversible causes of heart failure

Ischemic cardiomyopathy

Myocarditis:

Valve disease:

Toxic cardiomyopathy:

Genetic cardiomyopathy or idiopathic dilated cardiomyopathy

LV non-compaction cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy (ARVC)

Infiltrative cardiomyopathy: e.g. sarcoidosis, amyloidosis

Stacking disease: e.g. cardiac ATTR amyloidosis, haemochromatosis

Congenital heart disease, corrected or uncorrected