Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart is moderately enlarged . There is pulmonary vascular redistribution and patchy areas of alveolar infiltrate . There is a moderate - sized left effusion and small right effusion . There is volume loss in both lower lobes . dual lead pacemaker unnchaged .
    OUTPUT:
    
compared to the prior study the amount of fluid overload appears worsened