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The diagnosis of congestive heart failure was made when a patient had symptoms or signs of pulmonary congestion (shortness of breath and rales), signs of new left or right ventricular failure (cardiomegaly, an S 3 sound, jugular venous distention, and peripheral edema), abnormal results on chest radiography (vascular redistribution, interstitial edema, and alveolar edema), and a change in medication involving at least the institution of treatment with diuretic agents.

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