The process is initially triggered by some pathologic insult to the myocardium which causes damage that leads to the dysfunction described above. The myocardial systolic dysfunction, low cardiac output, results in the activation of hormones which further contribute to the heart's decline in function

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1. The process is initially triggered by some pathologic insult to the myocardium which causes damage that leads to the dysfunction described above. The myocardial systolic dysfunction, low cardiac output, results in the activation of hormones which further contribute to the heart's decline in function