All of these pathological processes injure the heart and decrease contractility. Ultimately a person with _______________ will experience pulmonary edema secondary to the back up of blood and high pressures into the pulmonary circulation. Clinical manifestations include dyspnea, orthopnea, cough with frothy sputum, fatigue, decreased urine output and edema. On exam you will observe cyanosis, pulmonary rales, pleural effusions, hypotension or hypertension, and an S3 gallop.