This patient support community is for discussions relating to angina, angioplasty, arrhythmia, bypass surgery, cardiomyopathy, coronary artery disease, defibrillator, heart attack, heart disease, high blood pressure, mitral valve, pacemaker, PAD, stenosis, and stress tests.
Scar tissue usually represent a prior ischemic (lack of blood flow) event to the area described. If the vessel providing blood the the specific area becomes occluded, that can be the cause. It is possible there was a clot that diminished the blood flow to the area. This could have happened without any symptoms and is medically referred to as a silent heart attack
Myocarditis is inflammation caused by by a bacteral infection or it can be inflammation from an unknown cause (ideopathic myocarditis)...drugs, medication, alcohol, etc. can be a source.
It is true you can have a normal life, etc. with some hypokinesis as the 45-50 efficiency is adequate especially if blood pressure is under control. The heart doesn't have a heavy workload. It has been estimated there about 26% of the heart problem population has an EF below 29% (heart failure range). The bottom of the heart doesn't require wall movement that is significant in the contraction (pumping) process.