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Although ascites is a common complication of congestive heart failure, the association between heart failure and hemorrhagic ascites is quite rare.A 64-year-old woman with recurrent large bloody ascites secondary to heart failure.Ascitic fluid assessment revealed red blood cells of 75,125/mm3 and white blood cells of 225/mm3. The total protein in the ascitic fluid was 28.7 g/L, with a high serum ascites albumin gradient. Peritoneal fluid examinations for bacterial culture, acid-fast bacilli (smear and culture), and malignant cell cytology were negative.The patient was managed with therapeutic paracentesis, aggressive diuresis, and optimization of her heart failure medications.The patient's symptoms improved dramatically and was discharged in a stable condition.Congestive heart failure should be considered as a potential cause of hemorrhagic ascites after ruling out other serious causes.