APPLIED PHARMACOLOGYAcute Heart FailureAdams, Amber PharmD, BCPS; Olesky, Courtney L. PharmD; Fisher, Allison PharmD, BCCCP; Justice, Stephanie Baker PharmD, BCPSEditor(s): Weant, Kyle A. PharmD, BCPS, BCCCP, FCCP, Column Editor Author Information UVA University Hospital, Charlottesville, Virginia (Dr Adams); and Cabell Huntington Hospital, Huntington, West Virginia (Drs Olesky, Fisher, and Justice). Corresponding Author: Stephanie Baker Justice, PharmD, BCPS, Cabell Huntington Hospital, 1340 Hal Greer Blvd, Huntington, WV 25701 ([email protected]). Disclosure: The authors report no conflicts of interest. Advanced Emergency Nursing Journal 44(3):p 178-189, July/September 2022. | DOI: 10.1097/TME.0000000000000414 Buy CE Test Metrics Abstract Heart failure impacts millions of Americans and has an approximate 5-year mortality rate of 50%–55%. Decompensation of this disease state could result in a patient's initial presentation and diagnosis or may reflect a worsening of a chronic condition that is being managed but needs optimization. Secondary to this, it is important for members of the health care team in the emergency department to recognize the presentation of this disease and manage the patient's signs and symptoms appropriately. Patients may be normotensive upon presentation or hemodynamically unstable. Those who are normotensive are often managed with loop diuretics and possibly low-dose vasodilators, whereas those who are hemodynamically unstable require more aggressive, focused care. It is important to note that some patients may present with respiratory failure and with no known history of heart failure. In these cases, a rapid and accurate diagnosis is critical. This article briefly summarizes the common acute clinical presentations of heart failure and the therapies considered first line for treatment based on the primary literature. © 2022 Wolters Kluwer Health, Inc. All rights reserved.