Acute heart failure poses a major healthcare problem. Recent guidelines for heart failure address management of outpatient chronic heart failure but do not address inpatient management. We present a unique, simple, yet comprehensive pathway that focuses on the differential diagnosis of new-onset heart failure and acute decompensation of chronic heart failure. An algorithm is presented for the optimal management of the patient with chronic heart failure who presents to the emergency room with acute symptomatic decompensation. The treatment algorithm provides recommendations for daily management and adjustments of therapy, which is primarily focused on a safe and rapid diuresis to the point of discharge from the acute care setting.