Heart Failure is a worldwide pandemic affecting an expected 26 million individuals worldwide and bringing about more than 1 million hospitalizations every year in both Europe and the United States, with the expectation of an increase in the number of cases over the following 2 decades. In this text, I have tried to describe different mechanisms that explain the wide spectrum of clinical manifestations seen in acutely decompensated heart failure. I have outlined the most appropriate pharmacologic treatments and highlighted best practices for each category, according to the latest research available. I also have identified areas in which guidelines are still not available and are subject to controversy and require further research.