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Heart failure is when the heart is unable to pump effectively, called systolic heart failure; or unable to fill properly, called diastolic heart failure. In both cases, blood output is reduced. Ejection fraction is reduced in systolic heart failure, but typically preserved in diastolic heart failure. The pathophysiology of heart failure involves a vicious cycle in which reduced cardiac output, as a compensatory response, activates the renin-angiotensin-aldosterone system (RAAS) and sympathetic system. However, these systems cause vasoconstriction, increase heart rate and blood pressure, making it even harder for the heart to pump. Increased aldosterone level also promotes ventricular remodeling, myocardial scarring, and vascular injury, worsening the disease. On the other hand, the natriuretic peptide system is also activated. This system is protective to the heart. It promotes vasodilation, sodium and water excretion, and inhibits cardiac remodeling. Most
