This patient is suffering from systolic heart failure. He would be expected to have a decreased cardiac index, increased systemic vascular resistance, and increased left ventricular end diastolic pressure.
Systolic heart failure is due to a weakened pumping function of the heart secondary to ischemic heart disease, chronic hypertension, or cardiomyopathy. This is in contrast to diastolic heart failure, which is characterized by the inability of the heart to sufficiently relax and fill with blood. Causes of diastolic heart failure may include hypertension leading to left ventricular hypertrophy, hypertrophic cardiomyopathy, amyloidosis, sarcoidosis, hemochromatosis, scleroderma, and fibrosis (either post-operative or radiation-induced).
Armstrong reviews recent guidelines on the management of heart failure (see illustration A for a description of the staging of heart failure). Stage A heart failure should be managed by addressing risk factors - hypertension and hyperlipidemia. Stage B and C heart failure requires the use of ACE inhibitors and beta-blockers to minimize symptoms. For patients with stage C disease that are retaining fluid, diuretics should also be added to the above regimen.
Kemp and Conte review the pathophysiology of heart failure. Compensatory mechanisms that may occur in heart failure include: increased stroke volume through Frank-Starling forces, ventricular remodeling leading to increased ventricular volume and wall-thickness, and neurohormonal activation leading to increased mean arterial pressure. These mechanisms initially help compensate for the failing heart and reduce the symptoms of heart failure; however, they ultimately contribute to worsening heart failure.
Illustration A details the staging of heart failure. Illustration B summarizes the pathophysiology of heart failure and its downstream effects. Illustration C highlights the different pathophysiology between systolic and diastolic heart failure.
Answer 1: Decreased systemic vascular resistance occurs due to systemic vasodilation, which may be a sequela of sepsis (most common), pancreatitis, cirrhosis, adrenal insufficiency, head injury, or beriberi.
Answer 2: Decreased LVEDP occurs in mitral stenosis.
Answers 4 & 5: Increased cardiac index may be seen in patients suffering from high-output cardiac failure; causes of this may include AV fistula, anemia, hyperthyroidism, beriberi, renal disease, hepatic disease, or sepsis.
Armstrong C. ACCF and AHA Release Guidelines on the Management of Heart Failure. Am Fam Physician. 2014 Aug 1;90(3):186-9.
PMID:25077725 (Link to Abstract)
Kemp CD, Conte JV. The pathophysiology of heart failure. Cardiovasc Pathol. 2012 Sep-Oct;21(5):365-71. doi: 10.1016/j.carpath.2011.11.007. Epub 2012 Jan 5.
PMID:22227365 (Link to Abstract)