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Framingham Criteria for Congestive Heart Failure

Diagnosis of CHF requires the simultaneous presence of at least 2 major criteria or 1 major criterion in conjunction with 2 minor criteria.

Major criteria:

·        Paroxysmal nocturnal dyspnea

·        Neck vein distention

·        Rales

·        Radiographic cardiomegaly (increasing heart size on chest radiography)

·        Acute pulmonary edema

·        S3 gallop

·        Increased central venous pressure (>16 cm H2O at right atrium)

·        Hepatojugular reflux

·        Weight loss  >4.5 kg in 5 days in response to treatment


Minor criteria:

·        Bilateral ankle edema

·        Nocturnal cough

·        Dyspnea on ordinary exertion

·        Hepatomegaly

·        Pleural effusion

·        Decrease in vital capacity by one third from maximum recorded

·        Tachycardia (heart rate>120 beats/min.)

Minor criteria are acceptable only if they can not be attributed to another medical condition (such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or the nephrotic syndrome).

The Framingham Heart Study criteria are 100% sensitive and 78% specific for identifying persons with definite congestive heart failure.

Related Criteria:

Estimate of 10-Year Risk for Coronary Heart Disease for Men (Framingham Point Scores)

Estimate of 10-Year Risk for Coronary Heart Disease for Women (Framingham Point Scores)

NYHA Functional Classification for Congestive Heart Failure

Cardiovascular Major Risk Factors

Braunwald Classification of Unstable Angina (UA)

Duke Criteria for Infective Endocarditis (IE)

Revised Jones Criteria for Acute Rheumatic Fever (ARF)

Wells Clinical Prediction Rule for Pulmonary Embolism and Deep Venous Thrombosis



  1. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971 Dec 23;285(26):1441-6. [Medline]

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Created: April 21, 2005
Last Modified: 10/17/2010

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