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hello Iamp;#39;m dr. Daniel Griffin and today we will be discussing congestive heart failure or CHF now one of the things I want to start by pointing out and I think weamp;#39;ve discussed this a few times is people may think when theyamp;#39;re going into practice so theyamp;#39;re going to less developed parts of the world that theyamp;#39;ll be seeing all kinds of communicable diseases all kinds of infections but the majority of deaths in the world are due to non communicable diseases and cardiovascular continues to be the leading cause of death in the world well cancer is kind of nipping at its heels another non communicable disease perhaps in some context one of the things that does change when you leave the u.s. is that when you leave Europe the United States certain temperate parts of the world and go into certain tropical parts of the world particularly Central and South America ischemic heart disease so lack of blood supply lack of oxygenation causing heart diseas