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1. Pathophysiology

   • Systolic
     • Left side
       • Affected by HTN, valvular dysfunction, CAD
         • Ventricle fails to pump
           • Baroreceptors cause SNS activation
             • Veins and arteries constrict to increase critical organ perfusion
               • Increased preload to increase contractile strength
                 • Reduced blood flow to the kidneys stimulating the RAA system which further vasoconstricts and increases Na++ and H2O retention
   • Diastolic
     • Stiff left ventricle
       • Decreased ventricular filling
         • Decreased stroke volume

2. Stages

   • Stage A: High Risk
     • No structural changes or s/s of HF
   • Stage B
     • Structural changes without s/s of HF
   • Stage C
     • Structural disease with prior or current s/s of HF
   • Stage D
     • Refractory HF

3. Non-Pharm Treatment

   • Salt Restriction

4. Pharmacologic Treatment- First Line

   • Loop diuretics
     • Relieves fluid retention
       • Decreased PVR
   • ACE-I or ARB
     • Prevents conversion of A1 to A2
       • Prevents vasoconstriction
   • Beta blockers
     • Decrease HR and increase filling time
       • Decrease O2 consumption
         • Lower B/P
   • Digoxin
     • Decreased HR
       • Increased filling time

5. Functional Outcomes

   • Edema
     • Daily weights
     • Support stockings
     • Nocturia
   • Respiratory Distress
     • Orthopnea
     • Exertional Dyspnea
     • Need for supplemental O2
   • Ascites
     • Hepatomegaly
       • Coagulopathy