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heart failure is a condition in which the heart is no longer able to meet the perfusion demands of the body acute heart failure is when this deterioration happens suddenly either in a previously healthy patient or in a patient with a previous cardiomyopathy these are known as de novo acute heart failure and acute decompensated heart failure lets start with a bit of physiology on the cardiac output which is the volume of blood pumped by the heart in a minute its given by the stroke volume multiplied by the heart rate remember not all the blood in the ventricle gets pumped out during systole the volume of blood in the ventricle before it starts contracting is around 110 milliliters known as the end diastolic volume shown here in purple typically only 70 milliliters gets pumped out and that is the stroke volume shown in orange ejection fraction is the fraction of blood in the ventricle is pumped out in this case it would be 70 divided by 110 giving around 64% a normal ejection fraction