KNOWLEDGE - Students should be able to describe:

  1. Define the terms preload, contractility and afterload and how these are affected in the heart with systolic dysfunction.   Figure 2331-6 and 2331-8 should be reviewed.
  2. Describe and define the compensatory mechanisms that are activated in systolic heart failure that involve the neurohumoral and cytokine systems:
  3. Apply the history to the classification of CHF in New York heart Association.
  4. Assign a risk and prognosis to patients in NYHA Class I< II< III< IV without vasodilator or beta blocker therapy.
  5. Outline a treatment plan for patients with symptomatic CHF using diuretics, digoxin, Vasodilators and beta blockers assign a risk reduction.



  1. Take a history and accurately assign a NYHA class in order to discuss prognosis and develop a treatment plan with your patient.
  2. Perform the key steps of the PE to detect the findings due to either right or left- sided failure.
  3. Critical in the evaluation of patients are:
  4. Develop a treatment plan for the stabilization and maintenance of patients with systolic heart failure.



  1. Patients with congestive heart failure as a diagnosis have a heightened awareness of the potential for dying.   The word “failure” must be appreciated explained to the patient and their tests addressed as an individual.
  2. The physician needs to be aware of the risk of therapy and develop a partnership with the patient the care plan.   Patients that are informed have insight into the treatment plan will be more compliant.   Their rights must be respected.  



  1. Jessup M. Brozena S.   Heart Failure    NEJM 348(20):2007-2018, May 15, 2003.

  2. Badgett R., Lucey C., Mulrow C.   The Rational Clinical Examination.   Can the Clinical Examination Diagnose Left-Sided Heart Failure in Adults?   JAMA 277(21):1712-1719, June 4, 1997

  3. Heart Failure, Harrison's On-Line: