Situs inversus describes a condition where organs are positioned in a \"mirror image\" of their normal anatomical location. The incidence is 1:5000 to 1:10000, is a recessive trait, and is more common in males. Associated congenital disorders include polysplenia, asplenia, horseshoe kidney, diaphragmatic hernia, and annular pancreas. Situs inversus can complicate interpretation of physical exam findings, but should be identified on exam of the heart and abdominal organs. Congestive Heart Failure (CHF) is the number one cause of older adult hospitalization. The most common etiologies are hypertension and coronary artery disease. Its incidence is actually increasing due to better treatments for MI and hypertension. It is associated with many age-related cardiovascular changes including reduced resting cardiac output, reduced responsiveness to B1 stimulation, increased vascular stiffness, valvular disease, increased afterload, decreased cardiac compliance, and increased reliance on \"atrial kick\" to compensate for reduced left ventricular filling. Other factors include decreased glomerular filtration rate, decreased responsiveness to diuretics, increased tidal volume and minute ventilation. Precipitating factors for attacks include cardiac factors (ischemia), sodium excess, excess fluid intake, medication non-compliance, volume overload, arrhythmias, drugs and medications, and associated medical conditions. Diagnosis is made clinically and from CXR. CXR can show linear interstitial patterns, effusion, vascular congestion, increased vasculature, and cardiomegaly. Treatment for acute CHF exacerbation includes oxygen, ventilation, vasodilators, diuretics, inotropic agents, and possibly morphine. Associated pulmonary edema and respiratory distress may require bronchodilators, steroids, and intubation. Serial CXR\'s while hospitalized can show responsiveness to treatment.