Heart disease may affect any area of the heart:

Heart valves
The valves within the heart may fail to develop properly, eg mitral dysplasia, or may degenerate as a result of ageing (endocardiosis). Specific infections can affect the heart valves (endocarditis). Abnormal valves allow leakage of blood between heart chambers even when they are closed. When valves leak abnormal blood flow can be detected when listening to the heart (a murmur) and on ultrasound.

Heart muscle
In general terms the heart muscle may be either too thick or too thin. If the muscle is too thin the heart is unable to contract properly and if the muscle is thick the heart cannot relax and therefore does not fill with blood between contractions. In either case the heart is unable to pump sufficient blood out.

Electrical conduction
Abnormal electrical conduction affects the rate and rhythm of the heart. Electrical abnormalities can be caused by disease outside the heart. If the heart beats too quickly there is not enough time for it to fill properly between beats and so it pumps less blood with each beat. If the heart beats too slowly there are not enough pulses to supply enough blood to the body. Chaotic rhythms occur where contractions of different parts of the heart are not synchronised and so pulse volume is reduced.

Pericardium
The pericardium is a strong sac that surrounds and supports the heart. Changes to the pericardium usually result in constriction of the heart, preventing it from filling properly between contractions. The right side of the heart (because it has thinner walls) is usually more easily compressed than the left. Diseases of the pericardium are very rare in cats.

Kittens can be born with heart defects (congenital heart problems) because the heart does not develop normally. The most common problems are leaky valves and holes inside the heart that allow blood to flow in abnormal directions. Heart disease in older cats is usually caused by changes in the heart muscle.