Three months after the initial diagnosis of acute heart failure syndrome, J.G. is dealing with CHF that will necessitate ongoing lifestyle changes. She monitors her weight, blood pressure, and pulse daily, keeping a log for her clinic visits. In total, she has lost about 40 pounds since her hospital admission. She continues with her medications and is at the target dose of the beta blocker. The ACE-inhibitor still is being titrated. She is losing weight gradually and is increasing her activity as tolerated. A repeat echocardiogram after two months of drug therapy showed an increase in her LVEF to 20%. A repeat BNP level at the same time was 849 pg/ml, a decrease of about 50% from baseline. BNP levels decrease in most patients who are receiving effective therapy for heart failure (Hunt et al., 2009). J.G.'s NYHA functional classification is III. She returned to work and is hopeful that diligent monitoring of her cardiac function will allow her to complete the school year in good health and eventually improve her NYHA functional classification to II. If her progress is compromised, an implanted pacemaker-defibrillator or implanted left ventricular assistive device may be considered. In patients with refractory and progressive heart failure, a heart transplantation might be required (Hunt et al., 2009).