Incardiomyopathy,theprocessofprogressive ventricular dilatation or hypertrophy takes place without ischaemic myocardial injury or infarction Fig. Thistriggersthereleaseofintracellularcalcium from the sarcoplasmic reticulum and initiates contraction see Fig. Relaxation results from the uptake and storage of calcium by the sarcoplasmic reticulum see Fig. In heart failure, there is a prolongation of the calcium currentinassociationwithprolongationofcontractionandrelaxation. Apoptosisisassociatedwithirreversiblecongestiveheartfailure,andthe spiral of ventricular dysfunction, characteristic of heart failure, results from the initiation of apoptosisbycytokines,freeradicalsandothertriggers. Inpatientswithheart failure,endothelium-dependentvasodilatationinperipheralbloodvesselsisimpairedandmay be one mechanism of exercise limitation. It does not include left ventricular ejection fraction as a meansofdeterminingseverityofheartfailure.
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