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my name is dr. Martin Brown and Im a general and advanced heart failure cardiologist with the Sydney cardiology group today were going to be talking about diastolic heart failure if you find this presentation useful you can access the slides via our website so were going to start off with a case of an 8 year old lady who has a background history of type 2 diabetes chronic renal failure and hypertension she presents two rooms complaining of pedal edema and exertional dyspnea when you examine her you notice that she has an elevated jvp normal heart sounds and by basal crepitations she also has swelling of her ankles you request a chest x-ray which shows you pulmonary edema but normal heart size the questions that wed like to address during this talk is what is the most likely diagnosis what further investigations would you like and what treatment will you instigate for this 80 year old lady so before we come to the answers to those questions Id just like to give you a little bit of