AF TO CHEThis assessment intends to explore management of an acutely ill 67-year-old man (Mr.X) who hassignificant deterioration of health with acute shortness of breath from Congestive heart failure (CHF)and associated Atrial fibrillation. Mr. X has history of chronic heart failure, type 2 Diabetes mellitus(T2DM), hypertension (HTN), Atrial Fibrillation (AF) and is current smoker and has history of alcoholabuse. On examination he was cold and clammy, with vitals showing hypotension of 80/45mmhg,Tachycardia with irregular heart rhythm, Atrial Fibrillation of rate 112beats/min, respiratory rate 26with increased work of breathing. He had significant edema on his lower limbs and exercisetolerance was limited to only moving around his bedside with worsening work of breathing. He wasnon-compliant with his medical management at home and was poorly following his fluid restrictionon this admission.Congestive heart failure is defined as the inability of the heart to pump enough blood to meet therequirements of the body. This is caused by different abnormalities in cardiac functions like loss ofcardiac muscle contractility, changes in blood pressure and blood volume, increased peripheraldemand (Gary S. Francis and Gary S. Francis, 2003). Mr X has significant risk factors to exacerbate hisCHF. This includes long term use of alcohol. Chronic use of alcohol can result in structural andfunctional impairment of myocardial cells leading to heart failure (Sahle et al., 2018). He also hashistory of diabetes.