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hi everyone and welcome back to tick me today I am absolutely stoked to be able to present a tutorial which combines two great loves of mine surfing and heart failure I know those two things dont seem very well matched to the start but by the end of this tutorial I hope that you will understand how they are so much better when you get before using waves to understand the principles of the pathophysiology this tutorial ties in with the last tutorial real time in real life and it provides an explanation for that patient symptoms if you havent done it is three minutes go back to technique on do you do that tutorial now and then you can ready to learn all about the pathophys right oh so jumping straight into it with normal left ventricular function left ventricular preload is always going to be optimized for the LVS contractility to keep the stroke longing consistent now remember the Frank styling curve which shows this lovely relationship with a lovely plateau phase where our normal hea