What condition can lead to myocardial insufficiency?

• A. Coronary artery blockage
• B. Atherosclerotic plaque elsewhere
• C. Valvular regurgitation
• D. Pulmonary hypertension

Answer: (A)

Blockage of a coronary artery directly cuts off oxygen-rich blood to part of the heart muscle. The myocardium relies on constant coronary blood flow to generate the energy needed for contraction. When flow is blocked, the affected area becomes ischemic, contractility decreases, and the heart’s pumping ability is impaired—this is myocardial insufficiency.

Atherosclerotic plaque elsewhere doesn’t necessarily affect the heart muscle unless it involves a coronary vessel. Valvular regurgitation causes volume overload and can contribute to heart failure over time, but it doesn’t by itself reduce the myocardium’s oxygen supply. Pulmonary hypertension places extra strain on the right ventricle, potentially leading to right-sided failure, but the primary issue is not direct myocardial insufficiency from reduced coronary blood flow.