Established clinical criteria for diagnosing congestive heart failure. Diagnosis requires two major OR one major plus two minor criteria simultaneously, in the absence of alternative explanation.

Parameters

Major Framingham HF Criteria

Paroxysmal Nocturnal DyspneaWake from sleep gasping for breath, requires sitting upright or getting out of bed to relieve dyspnea.Neck Vein Distension (Elevated JVP > 3 cm above sternal angle)Visibly elevated jugular venous pulse at rest, consistent with elevated right heart filling pressures.Rales (Crackles) on AuscultationBilateral basilar crackles on lung auscultation not cleared with coughing.Acute Pulmonary Edema on CXRRadiographic evidence of pulmonary vascular congestion, Kerley B lines, or overt alveolar edema.S3 GallopThird heart sound (S3) auscultated at apex — indicates rapid ventricular filling in the context of elevated filling pressures.Cardiomegaly on CXR (Cardiothoracic Ratio > 50%)Increased cardiac silhouette on posterior-anterior chest radiograph.Weight Loss ≥ 4.5 kg in 5 Days with TreatmentRetrospective major criterion — significant weight loss with diuresis supporting HF diagnosis.Central Venous Pressure > 16 cm H₂OElevated central venous pressure measured during invasive monitoring.

Minor Framingham HF Criteria

Bilateral Ankle EdemaBilateral pitting ankle edema not explained by venous insufficiency or hypoalbuminemia alone.Nocturnal CoughChronic nocturnal cough, often productive, typically worse in recumbent position.Dyspnea on ExertionExertional dyspnea not explained by primary pulmonary disease.HepatomegalyPalpable liver enlargement below right costal margin — suggests hepatic congestion from elevated right heart pressures.Pleural Effusion on CXRTypically bilateral blunting of costophrenic angles on CXR. Right-sided pleural effusion common in HF.Resting Tachycardia ≥ 120 bpmElevated resting heart rate as sympathetic compensatory mechanism.Vital Capacity Decreased by > 1/3 from Maximum RecordedRestrictive pulmonary pattern on spirometry from pulmonary congestion.

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CalculatorsFramingham Criteria for Heart Failure Diagnosis

CardiologyCriteria

Framingham Criteria for Heart Failure Diagnosis

Established clinical criteria for diagnosing congestive heart failure. Diagnosis requires two major OR one major plus two minor criteria simultaneously, in the absence of alternative explanation.

Parameters

Major Framingham HF Criteria

Paroxysmal Nocturnal DyspneaWake from sleep gasping for breath, requires sitting upright or getting out of bed to relieve dyspnea.Neck Vein Distension (Elevated JVP > 3 cm above sternal angle)Visibly elevated jugular venous pulse at rest, consistent with elevated right heart filling pressures.Rales (Crackles) on AuscultationBilateral basilar crackles on lung auscultation not cleared with coughing.Acute Pulmonary Edema on CXRRadiographic evidence of pulmonary vascular congestion, Kerley B lines, or overt alveolar edema.S3 GallopThird heart sound (S3) auscultated at apex — indicates rapid ventricular filling in the context of elevated filling pressures.Cardiomegaly on CXR (Cardiothoracic Ratio > 50%)Increased cardiac silhouette on posterior-anterior chest radiograph.Weight Loss ≥ 4.5 kg in 5 Days with TreatmentRetrospective major criterion — significant weight loss with diuresis supporting HF diagnosis.Central Venous Pressure > 16 cm H₂OElevated central venous pressure measured during invasive monitoring.

Minor Framingham HF Criteria

Bilateral Ankle EdemaBilateral pitting ankle edema not explained by venous insufficiency or hypoalbuminemia alone.Nocturnal CoughChronic nocturnal cough, often productive, typically worse in recumbent position.Dyspnea on ExertionExertional dyspnea not explained by primary pulmonary disease.HepatomegalyPalpable liver enlargement below right costal margin — suggests hepatic congestion from elevated right heart pressures.Pleural Effusion on CXRTypically bilateral blunting of costophrenic angles on CXR. Right-sided pleural effusion common in HF.Resting Tachycardia ≥ 120 bpmElevated resting heart rate as sympathetic compensatory mechanism.Vital Capacity Decreased by > 1/3 from Maximum RecordedRestrictive pulmonary pattern on spirometry from pulmonary congestion.

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