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good morning I'd like to thank the CCF and Kim Lin for inviting me to talk it's nice to see some familiar faces in the crowd and as well as some new faces as well I'm here to talk about the medical and surgical management of heart failure with a pediatric focus also trying to take a so-called mile high view some of the talks earlier this morning really got into the details I'll be a little bit less detail-oriented and more of the spirit of you know what are the doctors thinking when they leave the exam room and go back and talk about their patients to the nurse practitioner to the resonance and the medical students about this patient and how we approach heart failure hopefully to get you as patients and families a bit more insight into how we think and approach heart failure so I'm gonna go over by defining what is heart failure how do we characterize its severity what are the common presentations of heart failure and children and some broad strokes about the medical surgical and devi...