4.1. The heart muscle is weak and it has difficulty circulating enough blood for adequate oxygenation
4.2. The heart wall is stressed which leads to myocyte hypertrophy, death and regeneration which causes eccentric remodeling
4.3. The abnormal remodeling puts more stress on remaining myocytes which causes progression of the damage
4.4. This leads to hemodynamic and neurohormonal changes and activate the neuroendocrine systems
4.5. Norepinephrine, epinephrine, endothelin-1, and vasopressin cause vasoconstriction and increased cyclic adenosine monophosphate and cytosolic calcium. The calcium enters myocytes and impairs myocardial relaxation
4.6. All these process cause increased energy expenditure and decreased cardiac output which causes myocardial cell death and sets off RAAS resulting in salt and water retention
5. Diagnosis
5.1. Basic Natriuretic Peptide Level
5.2. Chest X-ray
5.3. ECG or Echocardiograph
5.4. Clinical findings
6. Treatment
6.1. Treat the cause
6.2. Decrease sodium intake, possible fluid restriction
6.3. Oxygen as needed
6.4. Light physical activity on a regular basis
6.5. Symptom relief with diuretics, mitrates, or digoxin
6.6. Management of condition with ACE, Beta Blockers, ARB,
6.7. ICD, Valve repair, CABG, heart transplant depending on general health and age