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and here you just see all of the symptoms that patients will have with heart failure they will be dismiss therell be short of breath you will find maybe their lips are blue because theyre not pumping enough oxygenated blood around there may be heart murmurs as we had in the patient in the last lecture with aortic stenosis sometimes on physical exam you will hear a loud extra heart sound that says the ventricles really hurting the patients breathing fast you may hear actually sounds from fluid in the lungs and so forth theres a whole variety of physical findings that the doctor finds that confirms the diagnosis of heart failure remember from the last lecture the most important thing are the symptoms they give you the clue 90% of the answer of the diagnosis is in the history you then move to the physical exam oh yes Im hearing things Im seeing things that suggest that the reason the patient is tired the reason the patient is short of breath the reason the patient has swelling in t