An 85 yo male went for check up. He is experiencing lower extremity edema and weight gain for 6 months. He has

hx of ischemic CAD, EF 45% for 10 years. He has poor follow up and stopped taking medications. An echo was done and found EF 25%. With natural history of CH, what mechanism is contributing to progression of his heart failure?

a.    Extracellular matrix disruption via matrix metalloproteinase

b.    Decrease serum levels of norepinephrine

c.    Increased sarcoplasmin reticulum calcium reuptake

d.    Falling levels of arginine vasopressin

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