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A patient with systemic congestion, jaundice and pedal edema is presented and the clinical approached is discussed. The clinical findings, along with the ECG, Chest xray and Echocardiogram are used to arrive at a diagnosis. A brief description of some of the conditions including restrictive cardiomyopathy, constrictive pericarditis, amyloid etc are discussed. The differential diagnosis at each stage of presentation i.e. history and examination are presented and discussed.