Definite congestive heart failure by Framingham criteria is present when either:

All criteria should be present concurrently and not better explained by another condition.

Major criteria	Minor criteria
Paroxysmal nocturnal dyspnoea or orthopnoea	Bilateral ankle oedema
Distended neck veins (jugular venous distension)	Nocturnal cough
Pulmonary rales	Dyspnoea on ordinary exertion
Cardiomegaly on chest x-ray (increasing heart size)	Hepatomegaly
Acute pulmonary oedema on chest x-ray	Pleural effusion on chest x-ray
Ventricular third heart sound (S3 gallop)	Decrease in vital capacity by ≥1/3 from maximum recorded
Increased central venous pressure >16 cm H₂O	Tachycardia ≥120 beats per minute
Hepatojugular reflux	Pulmonary vascular engorgement on chest x-ray
Pulmonary oedema, visceral congestion or cardiomegaly at autopsy
Weight loss >4.5 kg in 5 days in response to heart failure treatment

Framingham Heart Failure Diagnostic Criteria