His heart does look a bit larger than last time, but hopefully you noticed that this is a portable radiograph. That means that the image was performed in the AP instead of PA projection and the heart size is undoubtedly slightly magnified. There is no CHF.

Pulmonary vascular redistribution is an early sign of CHF, and means that the diameter of vessels in the upper parts of the lung is increased. In a normal patient, as shown here, the upper lobe vessels should be very thin, much smaller in diameter than the lower lobe vessels. In addition, the outer 1/3 of the lung should have virtually no markings, as shown in this normal case. In CHF, either linear (if edema is involving the interstitium) or ill-defined alveolar opacities (if edema has flooded the alveoli) may be seen in the outer as well as more central parts of the lung.