The most common causes of congestive heart failure include lowering the left ventricular myocardial utility and the dysfunction of the pericardium, myocardium, endocardium, heart valves or large vessels alone or in combination. Other pathogenic mechanisms that can lead to heart failure include excessive neurohumoral stimulation, irregular myocyte calcium cycling, augmented hemodynamic overload, ischemic dysfunction, ventricular remodelling, extreme or inadequate extracellular matrix production, enhanced apoptosis, and genetic mutations.