What is the role of the coronary circulation in congestive heart failure?

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Abstract
Manifestations of congestive heart failure are frequently observed in patients with coronary disease. However, they may be predominant in patients who have sustained prior myocardial infarction, in whom left ventricular aneurysm or papillary muscle dysfunction may induce left ventricular dysfunction. A small group of patients can develop severe cardiac insufficiency and pump failure on the basis of diffuse occlusive coronary artery disease. Heart failure can also be induced by congenital coronary abnormalities and in congestive cardiomyopathy some previous studies have suggested a decrease of coronary blood flow per unit of myocardial mass. Moreover, coronary artery disease can be associated and worsened congestive heart failure can result from other causes (e.g. valvular disease). However, congestive heart failure per se can also disturb coronary circulation as a result of changes in subendocardial myocardial perfusion or metabolism.

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