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so of course were going to do some tests to confirm our clinical impression weve had the history oh this suggests heart failure the patient short of breath they have peripheral edema oh we listen to the heart and we hear on extra sound the s3 gallop okay weve now pretty sure the patient has heart failure then we do a chest x-ray you can see the two examples here the one on that one side is normal and the one on the other side that shows an enlarged heart sometimes we will even see evidence of fluid in the lungs pretty obvious on this chest x-ray this is called pulmonary edema the left ventricle has failed docHubly and what we see is fluid throughout the lungs and of course this patient is very short of breath they might be breathing at 30 or 40 times a minute normal is about 12 13 14 times a minute and they met you may actually hear gurgling from this fluid thats collecting in the small alveolar sacs in the lung and being transmitted into the into the bigger bronchial tubes no