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my disclosures i have no conflicts related to this presentation i received no funding from pharma or from industry for uh this presentation or any of my education work and all the content is essentially developed by myself so in order to understand the management of heart failure we need to understand a little bit about the pertinent pathophysiology of what happens to the patient who goes into heart failure if we understand the basic pathophysiology then it will become very clear where the therapeutic targets are and which medications are going to be effective so going back many many years to the frank starling law taking you back to your medical school days and you know that there is a relationship between left ventricular and diastolic volume or pressure and the stroke volume and in the normal situation as the left ventricular volume increases or pressure then the stroke volume increases but when you have systolic dysfunction of the heart the curve is shifted downwards and to the rig