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everyone thank you for joining me again were going to talk about an acute heart failure case today and thinking about things as they go along the minute-by-minute so lets get straight into the case we have a 70 year old male his wife called an ambulance as he was unable to get out of his chair today hes had progressive shortness of breath at rest over the last three days and wife says his legs have swollen and hes been dragging his feet along the floor when he does walk the last three to four weeks hes had difficulty walking and increasing difficulty getting out of that chair and hes been coughing up clear sputum for a bit longer than that hes got no fevers no no bladder pain pain anywhere else any other infective features no coughs colds or sniffles hes been unable to lie flat for about a month and hes using three pillows when he was scanned he do need to ask specifically he also wakes up short of breath in the middle of the night and has to sit upright for relief and thats