This report presents a detailed analysis of a case study involving a 78-year-old female, Mrs. Brown, diagnosed with an acute exacerbation of chronic systolic heart failure. It explores the pathogenesis of the condition, linking it to heart dysfunction, irregular heart rhythm, and reduced cardiac output. The report delves into the compensatory mechanisms, including the sympathetic nervous system and the renin-angiotensin-aldosterone system, and discusses the impact of these systems on heart function. It outlines nursing strategies to manage symptoms such as shortness of breath and atrial fibrillation, including pharmacological interventions like Dabigatran, Rivaroxaban, and oxygen therapy. Furthermore, the report explains the mechanisms of action of IV furosemide (Lasix) and glyceryl trinitrate (GTN), detailing how these drugs help in managing heart failure by regulating fluid balance and heart muscle relaxation. References support the evidence-based practices discussed throughout the report.