### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Have had heart failure.mitrel valve replaced.had heart attack six months ago.now I feel very breathless rapid heartbeat.very tired and cough.this has started yesterday.my back is painful. (Left side) on beater blockers warfin aspirin fluid tablets (40mg) in bed now resting but my breathing is very heavy.have to see doctor tomorrow about my Inr.history of clots.thank you.

### output:

Hello! Welcome and thank you for asking on Chat Doctor! I understand your concern, and would like to explain that your clinical situation appears a bit complicated. You have a history of previous diagnosed heart failure from a valve disorder, also a recent heart attack. Both of them have clear implications of a decreased cardiac performance. Possible responsible factors may have influence on heart failure decompensation, like an underlying inflammation/infection, a new onset cardiac arrhythmia, an acute coronary syn Chat Doctor. To better differentiate between several possible etiological factors, a careful physical exam, coupled with a resting ECG and cardiac ultrasound, chest X-ray study and several blood tests (like complete blood count, PCR, blood electrolytes, CK-MB, troponin I, AST & ALT, bilirubin, etc.) are necessary. A therapy optimization (potentially increasing diuretics doses, modulating beta-blockers regimen according to HF status and possible arrhythmia, and starting antibiotics for possible infection, etc.) would be necessary. You need to discuss with your attending physician about these issues. Hope to have been helpful to you! Feel free to ask me in case of further uncertainties. Greetings! 