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Congestive heart failure begins with damage or weakening to the heart muscle, often due to clogged arteries from coronary artery disease or increased afterload from chronic hypertension. This weakening reduces stroke volume, which is the amount of blood pumped by the heart with each beat, resulting in decreased cardiac output. To compensate, the heart may increase heart rate, but this comes with consequences. Structural changes in the heart muscle may also occur in an attempt to maintain cardiac output.