There are many potential pathologies that cause a patient to have a complaint of shortness of breath and it may not always be easy to differentiate between heart failure, COPD/asthma and pneumonia. Misdiagnosis of heart failure is common and inappropriate treatment may be harmful. It has been shown that 25% of patients given furosemide developed significant electrolyte imbalances and hypotension requiring fluid boluses; adding morphine increased mortality by 22% compared to 2% with only nitroglycerin. If you have any question about the diagnosis, it would be appropriate to treat your patient with bronchodilators, nitroglycerin and NIPSV, avoiding morphine and furosemide. Remember that heart failure might be the result of an AMI, so it is important to consider aspirin as well.