A 75-year-old obese patient with NYHA IV dyspnea on loop diuretic therapy, left atrial enlargement, and elevation of systolic pulmonary pressure, a measured NT-proBNP level of 2,850 pg/ml, and five previous hospitalizations for HF would achieve 423 points in the nomogram, which then translates into a HALO score of approximately 3. Here, NPPB is linked to hydrops fetalis.