Wiki Heart Failure with exacerbation

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Not necessarily. Exacerbation just means flare-up. Something is making the heart failure worse. "acute systolic heart failure" would mean "this patient's heart was fine yesterday but now it isn't." If that's what's happening here, then yes I50.21 would be appropriate. If the patient has chronic heart failure, then it's probably just a plain old I50.20.
 
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