The coronary artery disease (CAD) is a major contributor to heart failure. It reduces the blood flow and supply of oxygen to the myocardium, leading myocardial hypoxia and reduced function. Another broad mechanism involving myocardial infarction is also associated with the heart failure. Myocardial infarction is considered serious, and it reflects the peak of coronary artery disease. The infarcted tissue fails in functional mechanical processes, which eventually lead to reduced cardiac function. In addition, healthy tissues are required to compensate for the diminished functions, which result in additional work that can lead to heart failure (Boudoulas, Borer, & Boudoulas, 2015). Congenital impairments and valvular disease could also cause heart failure because of increased activities. Cardiomyopathies of both identified and unidentified causes are responsible for heart failure. It is also observed that myocarditis can also lead to the same outcome. Finally, arrhythmias, which mainly include tachycardia or bradycardia could also cause heart failure (McCance & Huether, 2014). In the case, the patient shows multiple signs associated with the coronary heart disease, which is associated with shortness of breath, irregular heartbeats, faster heartbeats (tachycardia with a heart rate of 110 bpm), fatigue, and hypertension (Ferrari & Fox, 2016). The patient’s condition has be aggravated by other factors, such as type 2 diabetes and advance age (66 years old). Additionally, an enlarged heart would result in the noted beat and additional heart sounds, which generally depict elevated intra-cardiac blood pressure. The patient has also recorded fine crackles (heart murmurs) on inspiration at both bases. The cardiac exam is noted for the presence of a third and fourth heart sound while jugular venous distension is conducted to determine the status of the fluid responsible for edema. These fine heart crackles could reflect valvular heart disease, as either a direct cause or a consequence of heart failure. The patient’s physical examination has revealed more than two pitting edemas to the knees bilaterally. A possible backward failure in the right ventricle is responsible for the congestion of the capillaries (Ferrari & Fox, 2016). As a result, the patient has experienced body fluid accumulation. In this case, the accumulated body fluid has affected the legs and knees, making walking more difficult. The patient will experience swelling of the knees, ankles, and feet when she stands up and later suffers sacral edema when she lies down. Systolic dysfunction is noted in the left ventricle when it cannot contract as required. It reflects pumping impairment in the heart. Conversely, diastolic dysfunction reflects inability of the left ventricle to fill fully or relax. It is generally a problem of filling in the heart. This dysfunction shows the preserved ejection fraction associated with heart failure (the patient has recorded an estimated ejection fraction of 25%) (Al-Sofiani, Nikolla, & Metta, 2015). The patient must be experiencing failure of the left ventricle (Al-Sofiani et al., 2015). It is responsible for congestions of the blood vessels in the lungs, resulting in respiratory challenges associated with shortness of breath (dyspnea). Dyspnea is noted on exertion, but in the case, the condition is severe and, therefor