• Altered myocardial contractility/inotropic changes
• Alterations in rate, rhythm, electrical conduction
• Structural changes (e.g., valvular defects, ventricular aneurysm)

Possibly evidenced by

• Increased heart rate (tachycardia), dysrhythmias, ECG changes
• Changes in BP (hypotension/hypertension)
• Extra heart sounds (S₃, S₄)
• Decreased urine output
• Diminished peripheral pulses
• Cool, ashen skin; diaphoresis
• Orthopnea, crackles, JVD, liver engorgement, edema
• Chest pain

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