Heart failure (HF) is a complex syndrome that involves both acute and chronic processes. Acute decompensated heart failure (ADHF) defined as the onset of symptoms or signs of HF in a patient with no prior history of HF, and previously normal function is an uncommon cause of ADHF. This chapter summarizes the available diagnosis and treatment strategies for the management of ADHF. This condition can be diagnosed by electrocardiogram, chest radiography, laboratory data (complete blood count, serum creatinine, serum electrolytes, etc.), echocardiography, coronary angiography and so on. The treatment strategies of ADHF include loop diuretics, ultrafiltration, vasodilation, natriuretic peptides and pharmacologic agents (rolofylline, relaxin, omecamtiv mecarbil, etc). The initial goal of treatment of ADHF is to stabilize the patient’s condition with conservative measures that improve patient comfort, avoid mechanical ventilatory support, limit cardiac ischemia and attenuate the need for hospital admission.