When the failure is mild, a combination of sympathetic stimulation and fluid retention may be enough to completely restore the cardiac output to normal. When the patient is resting, the only indication that failure is present would be an elevated atrial pressure. This condition is called compensated failure. Such a compensation, however, is at the expense of the reserve of the heart, and as a result the ability of the heart to increase cardiac output during exercise would be compromised. In some patients, the decrease in contractility is so severe that no amount of sympathetic stimulation or increased atrial pressure can restore the cardiac output, in which case the cardiac output even at rest will be inadequate.
Fluid retention will continue, even though further elevation of atrial pressure actually decreases the cardiac output and causes a positive-feedback spiral of deterioration. Heart failure in this case is said to be decompensated.
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