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Abstract
        Heart failure (HF) is a complex clinical syndrome rather than a disease and can result  from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill  with or eject blood. Although the cardinal manifestations of  HF are dyspnea and fatigue that limit exercise tolerance, and fluid retention that leads to  pulmonary congestion and peripheral edema, physical manifestations of HF  are heterogeneous. For example, patients with dyspnea and fatigue may not present with signs  and symptoms of fluid overload and pulmonary congestion and those with fluid overload may  not present with fatigue and dyspnea.