How do we classify heart failure patients at the bedside? This 2×2 table is a simple clinical tool used to assess patients with heart failure based on two key questions: 1️⃣ Is there congestion at rest? Look for signs like orthopnea, elevated jugular venous pressure, pulmonary rales, S3 gallop, or leg swelling. 2️⃣ Is there low perfusion at rest? Check for signs like narrow pulse pressure, cold hands/feet, dizziness, low blood pressure, or fatigue. Based on yes or no to each, patients fall into one of four profiles: 🔴 Warm and dry • Good perfusion, no congestion • This is the ideal, compensated state 🟡 Warm and wet • Good perfusion, but fluid overload • Most common in acute decompensated HF • Needs diuretics and afterload reduction 🔵 Cool and dry • Poor perfusion, but no fluid overload • Often seen in advanced HF • Needs inotropes or optimization of volume 🟢 Cool and wet • Poor perfusion and congestion • Worst prognosis • Requires urgent intervention: diuresis + inotropes ± mechanical support ✅ This simple classification helps guide initial treatment decisions and is widely used in emergency and inpatient settings for managing acute heart failure.