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so were thinking about the pathophysiology of heart failure now if you want an information burst turn this video off now is not for you but if you want to think through it with me the same way as I do with my students then it is for you but its going to require a bit of thinking on your behalf so theres going to be death of the myocytes the contractile muscle cells in the myocardium thats going to be myocyte loss loss of the minor size and we know theres going to be fibrosis in the myocardium particularly thinking about the ventricular myocardium and its this thats going to release lead to the heart failure so the impaired ventricular function is the primary pathology the primary abnormality in heart failure and unless the heart failure is caused by valve disease but in most cases of our friend is not well in all cases of heart failure not caused by valve disease the problem is impaired ventricular function and this is going to reduce cardiac output remember the cardiac output