This directed case study centers on the story of a 65-year-old man with a weakened ventricle, resulting in reduced cardiac output. Students are provided with a description of the patient’s acute heart failure event and a hospital chart that includes his history, physical exam, blood test results, chest X-ray, ECG and ejection fraction. Students review this information in order to answer a series of 18 questions. Background information explains the importance of maintaining mean arterial pressure (MAP) and the factors that contribute to MAP, including cardiac output, total peripheral resistance and blood volume. Also described are three volume/pressure regulating hormone systems: renin angiotensin, aldosterone system (RAAS); antidiuretic hormone (ADH); and atrial natriuretic peptide (ANP) and brain (ventricular) natriuretic peptide (BNP). The use of Entresto (sacubitril/valsartan), a novel drug used in treating patients with acute heart failure, is also considered. The case was developed for college-level pre-nursing, pre-med, biology, and physiology students.