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congestive heart failure pathophysiology overview and boy is it a vicious cycle congestive heart failure usually starts from some kind of damage or weakening to the heart muscle usually caused by clogged arteries due to coronary artery disease or increased afterload from chronic long-term hypertension this then this weakening of the heart decreases stroke volume stroke volume is the amount of blood pumped by the heart with each beat so stroke volume goes down down goes cardiac output which is the amount of blood thats pumped by the heart in a minute now the heart has a couple of compensations that well make to try and increase cardiac output one of those is to increase heart rate because if you can increase heart rate you could increase cardiac output however all compensations come with a price tag and in this case the price tag is less time to fill another compensation that well see by the heart our structural changes and these are made the structural changes in the heart muscle a