Depressed

ejection fraction Injury to the cardiac muscle High-Outp

(<40%) - Thyroto
- Coronary heart disease - Beri-Ber
- Hypertension Loss of function of cardiac
myocytes - Chronic
- Chronic volume overload - Arteriove

Decreased ability of the

Preserved ejection fraction myocardium to generate force
(>40-50%) Pulmona
- Aging - Pulmonary h
Decreased cardiac
- Pathologic hypertrophy contractility
- Pulmonary v
- Restrictive cardiomyopathy

Decreased stroke volume

Decreased cardiac output

Unloading of high pressure

baroreceptors in carotid sinus
and aortic arch

Anterior lateral portion of Efferrent sympathetic Stimulation of the cardiac regulatory

upper medulla nervous sytem center in the pons and medulla
put States
oxicosis
ri
c anemia
enous fistula

ary Disease
hypertension
vascular disease
 Release of arginin
(ADH) from the an
Vasoconstriction of blood
Renal hypoperfusion Damage to the filtration barrier
vessels

Vasocons
Inability to filter creatinine
Release of renin

High creatinine levels

Increased permeab
Converts Angiotensinogen collecting
to Angiotensin I
DPP4- Linagliptin

ACE converts Angiotensin I Vasoconstriction of the

to Angiotensin II peripheral vasculature

Aldosterone

Reabsorption of water and

electrolyte

Increased preload Increased afterload

Increased end systolic

Increased cardiac output Excessive beta activation
volume (LV)

Increased pulmonary
Increased wall stress capillary pressure
in the LV
ne vasopressin
nterior pituitary

triction

bility of the renal

g ducts

BP 160/100

Transcriptional and post-

transcriptional changes in the
genes and proteins

Increased force of
contractility

Remodeling of the left

ventricle
 Increased heart rate
Pulmonary congestion
Thinning of the wall of the
LV
Decreased diastolic filling
Lea
Airway obstruction
Afterload mismatch
Furosemide

Reduced Dyspnea and

FEV1/FVC ratio; V/Q Mismatch Orthopnea Stiff
Further decrease in SV
Increased TLC v
and RV

Pooling of blood in the right Increa

Digoxin Decreased cardiac output pressur
atrium and the vena cava
v

HEART FAILURE Pooling of blood in the

venous circulation
akage of Ca

fening of the
ventricles

Furosemide

ased hydrostatic
re in the peripheral Peripheral Edema
vasculature

Neck vein distention

Hepatomegaly