Causes: (1) acute decompensated HF: long standing CHF, tachypnea, pulmonary crackles, jugular venous distention, S3 gallop, peripheral edema, (2) renal failure: usually ESRF patients, (3) pericardial effusion and cardiac tamponade: acute trauma or wall rupture presenting as cardiogenic shock or subacute accum. of fluid from infective, uremic, neoplastic, post-MI or autoimmune causes, check for hypotension, distended neck veins, muffled heart sounds +/- pericardial rub, reduced pulse pressure and pulsus paradoxes (abnormally large decreased BP on inspiration), (4) decompensated cirrhosis: ascites and jaundice