When myocardial dysfunction is present, there can be a decrease in the efficiency of pumping to the left and/or right ventricles. This change occurs because of ventricular dilation, deficient systolic function, ventricular hypertrophy and deficiency in diastolic function or as a result of diastolic restriction because of stiffening of the ventricular wall, hindering ventricular filling and limiting cardiac output (Wynne and Braunwald, 2008).