Table 4.

Possible causes of myocardial injury in primary cardiac disease

Initiating or contributing cause
Genetically abnormal myocyte function160, 161
Ventricular hypertrophy (subendocardial ischemia)156, 162
Fibrosis111, 158
Hemodynamic overload (altered calcium‐handling)33
Increased myocardial wall stretch34, 163
Endothelial/microvascular dysfunction157, 164
Activation of the renin–angiotensin–aldosterone system165
Activation of the sympathetic nervous system (norepinephrine toxicity)30, 166, 167
Toxic effects of inflammatory cytokines168, 169
Oxidative stress170
Troponin autoimmunity171, 172
Systemic hypotension46, 173, 174
Anemia175
Arrhythmia90, 175, 176
Inotropic drugs46, 173, 174