Common final manifestation of several known and many unknown myocardial insults, secondary to: Chemical toxins - chemotherapeutic agents, cocaine. My heart is a muscle and it pumps blood like a big old black steam train" 1. Let"s start with the left ventricle . Reduced pump function may result from. A fall in contractility of the myocardium (fig. Heart failure (hfref) with reduced left ventricular systolic function. Atherothrombotic occlusion of a coronary artery results in regional myocardial infarction. Myocardium is replaced by scar tissue, with reduced contractile function in that region. Coronary artery disease is the most important cause of heart failure in developed countries. Heart failure with reduced left ventricular systolic function. Atherosclerotic narrowing of a coronary artery (usually>70%) results in reduced function of viable myocardium. The myocardium has reduced mitochondrial function, increased apoptosis and fibrosis but can recover fully if normal blood supply is restored (e. g. by angioplasty) Coronary artery disease results in regional impairment of ventricular function.