PREMIUM Registry: PRognostic HEModynamIc Profiling in the AcUtely Ill EMergency Department Patient

Inclusion Criteria: General Inclusion Criteria * 18 years of age or older * Able to provide informed consent * No initiated therapy since arrival to the ED * Must be enrolled within 4 hours of arrival to the ED Inclusion Criteria for Acute CHF * Recurrent or worsening (within 3 days) shortness of breath as the primary presenting ED complaint * Initial treating ED physician impression that the worsening dyspnea is most likely caused by decompensated CHF * Known history of physician diagnosed CHF * Natriuretic peptide (BNP, MR-pro ANP, NT pro BNP) level will be ordered by the treating physician as part of the patient's work up Inclusion Criteria for Acute Stroke Syndrome * Onset of abnormal neurological symptoms consistent with possible stroke, within the prior 24 hours, as the primary ED complaint * Initial treating ED physician impression that the abnormal neurological symptoms/signs are most likely caused by an acute stroke syndrome * Non contrast head CT will be ordered by the treating physician as part of the patient's work up Inclusion Criteria for Acute Systemic Infection * Any combinations of acute (within 3 days) symptoms and signs that the treating ED physician, after initial history and physical examination, attributes to a systemic infection * Blood cultures and/or a blood lactate will be ordered by the treating physician as part of the patient's work up Exclusion Criteria: General Exclusion Criteria * ESRD requiring hemo or peritoneal dialysis * Suspected pregnancy * Not able to be followed up in 30 days * Patients with "comfort only" DNR status * Patients with known STEMI * Excessive agitation * Transferred from another treating facility * Known aortic valve disease * On continuous IV home infusions (such as milrinone, primacor) * Known Left Ventricular Assist device (LVAD) * Known prior enrollment in this study * In current therapeutic Investigational study