Vital signs: temp 37.5° C, BP = 110/70 mmHg, PR = 120 bpm, RR = 26/min , Lungs: fine crepitation both lungs, trachea in midline General appearance: an elderly Thai woman, good consciousness, dyspnea ,Cardiovascular: JVP engorged up to chin,No active precordium, no apical or parasternal heaving,Normal S1 S2 with S3 gallop,Extremities: pitting edema 2+ both legs, capillary refill 3 seconds, weak pulses