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good morning everybody we are continuing our series on different um chronic conditions treat to target and today im going to just be focusing on heart failure we have an amazing guideline that came out in 2016 on the diagnosis and treatment of acute and chronic heart failure which is an international guideline but was also endure endorsed by the south african cardiology cardiology society so what were going to look at is a very pragmatic approach to heart failure so im not going to be covering any of the pathophysiology and if we briefly look at what we mean when we say heart failure were actually talking about a clinical syndrome and most of what youre doing when youre diagnosing heart failure is youre looking at the clinical picture of your patient so theres very typical symptoms that the patients present with classically theyre breathless or they have some swelling of the ankles and the one we always need to look out for and we sometimes forget is exertional fatigue so for