EMERGENCIES: Edited by Alan E. JonesEarly emergency management of acute decompensated heart failureSummers, Richard L.; Sterling, SarahAuthor Information Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA Correspondence to Richard L. Summers, MD, Department of Emergency Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216, USA. Tel: +1 601 984 5572; e-mail: [email protected] Current Opinion in Critical Care: August 2012 - Volume 18 - Issue 4 - p 301-307 doi: 10.1097/MCC.0b013e328354f05a Buy Metrics Abstract Purpose of review Acute decompensated heart failure (ADHF) is characterized by a complex spectrum of pathophysiology that emerges as a common clinical disease state, which manifests as a failure of the circulation to provide for the needs of the body systems. Whereas ADHF is often characterized by the findings of pulmonary congestion and dyspnea, a variety of clinical presentations are possible, with each requiring differing management strategies. This review examines the approach of the four-quadrant clinical profile for differentiation of the ADHF patient during the emergent resuscitative phase of the decompensation. Recent findings Clinical and diagnostic information can be used to determine the relative degree of pulmonary congestion and peripheral tissue perfusion in patients suspected of ADHF. This information can be used in a four-quadrant approach to differentiate patients into pathophysiologic categories. These profiles can then be translated into management strategies from a physiology based perspective in which the specific mechanisms of the failure are targeted. Summary ADHF can present in a variety of clinical forms in the emergent setting. Categorization of the ADHF patient according to their individual hemodynamic profile can assist in management decisions during the emergent resuscitative phase of the decompensation based upon an approach that targets causative pathophysiologic mechanisms. © 2012 Lippincott Williams & Wilkins, Inc.