Patient presents with acute exacerbation of congestive heart failure (CHF).  Symptoms include worsening dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and lower extremity edema.  The patient reports increased fatigue and decreased exercise tolerance compared to baseline.  On physical exam, the patient exhibits bibasilar rales, jugular venous distension (JVD), and pitting edema in bilateral lower extremities.  The patient's weight has increased by 3 kg since their last visit.  Cardiac exam reveals an S3 gallop.  Review of systems is positive for dyspnea, fatigue, and edema.  Past medical history significant for chronic heart failure, hypertension, and hyperlipidemia.  Current medications include lisinopril, metoprolol succinate, furosemide, and atorvastatin.  Assessment: Heart failure exacerbation likely secondary to volume overload.  Plan:  Increase furosemide dosage, optimize fluid restriction, and closely monitor electrolytes.  Consider addition of intravenous diuretic if no significant improvement within 24 hours.  Echocardiogram ordered to assess cardiac function.  Patient education provided on fluid management and symptom monitoring.  Follow-up scheduled in one week to assess response to treatment. Differential diagnosis includes acute coronary syndrome, pulmonary embolism, and pneumonia.  ICD-10 code: I50.9 Heart failure, unspecified.