Heart failure is defined as when the heart cannot meet the body’s demands. This can occur by two different mechanisms. The first is a systolic heart failure which is when the heart does not have the ability to pump the cardiac output needed. The second type is diastolic heart failure when the heart chambers cannot be filled enough. Both systolic and diastolic heart failure lead to blood backing up in the lungs, which is why it is called “congestive heart failure.” Congestive heart failure (CHF) affects millions of people worldwide and can ultimately lead to death if not treated. In this case, an acute presentation of congestive heart failure is used to help students learn about altered fluid balance, cardio-renal mechanisms involved in patient deterioration, and cardiogenic shock.