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Upon completion of the chapter, the reader will be able to:

  1. Differentiate between the common underlying etiologies of heart failure, including ischemic, nonischemic, and idiopathic causes.

  2. Describe the pathophysiology of heart failure as it relates to neurohormonal activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system.

  3. Identify signs and symptoms of heart failure and classify a given patient by the New York Heart Association Functional Classification and American College of Cardiology/American Heart Association Heart Failure Staging.

  4. Describe the goals of therapy for a patient with acute or chronic heart failure.

  5. Develop a nonpharmacologic treatment plan that includes patient education for managing heart failure.

  6. Develop a specific evidence-based pharmacologic treatment plan for a patient with acute or chronic heart failure based on disease severity and symptoms.

  7. Formulate a monitoring plan for the nonpharmacologic and pharmacologic treatment of a patient with heart failure.




  • Image not available. The most common causes of heart failure are coronary artery disease (CAD), hypertension, and dilated cardiomyopathy.

  • Image not available. Development and progression of heart failure involves activation of neurohormonal pathways, including the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS).

  • Image not available. The clinician must identify potential reversible causes of heart failure exacerbations, including prescription and nonprescription drug therapies, dietary indiscretions, and medication nonadherence.

  • Image not available. Symptoms of left-sided heart failure include dyspnea, orthopnea, and paroxysmal nocturnal dyspnea (PND), whereas symptoms of right-sided heart failure include fluid retention, GI bloating, and fatigue.

  • Image not available. General therapeutic management goals for chronic heart failure focus on preventing onset of clinical symptoms or reducing symptoms, preventing or reducing hospitaliza-tions, slowing or preventing disease progression, improving quality of life, and prolonging patient survival.

  • Image not available. Nonpharmacologic treatment involves dietary modifications such as sodium and fluid restriction, risk factor reduction including smoking cessation, timely immunizations, and supervised regular physical activity.

  • Image not available. Diuretics are used for relief of acute symptoms of congestion and maintenance of euvolemia.

  • Image not available. Agents with proven benefits in improving symptoms, slowing disease progression, and improving survival in chronic heart failure target neurohormonal blockade; these include angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), β-adrenergic blockers, and aldosterone antagonists.

  • Image not available. Combination therapy with hydralazine and isosorbide dinitrate is an appropriate substitute for angiotensin II antagonism in those unable to tolerate an ACE inhibitor or ARB or as add-on therapy in African Americans.

  • Image not available. Treatment of acute heart failure targets relief of congestion and optimization of cardiac output utilizing oral or IV diuretics, IV vasodilators, and when appropriate, inotropes. Current treatment strategies in acute heart failure target improving hemodynamics while preserving organ function.


Heart failure (HF) is defined as the inadequate ability of the heart to pump enough blood to meet the blood flow and metabolic demands of the body.1 High-output HF is characterized by an inordinate increase in the body's metabolic demands that outpaces an increase in cardiac output (CO) of a generally normally functioning heart. More commonly, HF is a result of low CO secondary to impaired cardiac ...

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