Liver in heart failure. Close-up of a section through the liver of a person affected by heart failure. Heart failure occurs when the heart is unable to pump efficiently enough to maintain a sufficient blood flow to meet the demands of the body. Common causes include coronary artery disease, high blood pressure and atrial fibrillation. In right-sided heart failure there is an increase in blood pressure upstream of the right side of the heart, in the vena cava. This has an impact further upstream in the hepatic veins, which drain de-oxygenated blood from the liver, causing cytolysis (cell death), which can lead to liver failure.