<i>Background:</i> The traditional medical treatment of acute heart failure (AHF) has remained unchanged for many years. It has been based on oxygen supplementation and mechanical ventilatory support as well as the administration of morphine, diuretics, nitrates and inotropic agents. In 2005 the European Society of Cardiology (ESC) published new guidelines on the diagnosis and treatment of AHF. Also, new therapies have been introduced recently, giving rise to changes in therapeutic concepts. <i>Material/Method:</i> Based on these new guidelines and recent studies selected from the literature we here describe the new ESC classification of AHF including its epidemiology and pathophysiology. We further present a state-of-the-art status of the choices of medical treatment for patients with acute decompensated heart failure and pulmonary edema. <i>Results:</i> Mechanical ventilatory support reduces the number of patients who require endotracheal intubation.Nitrates in dosages higher than employed today appear to be beneficiary to patients with pulmonary congestion, probably because of the pronounced afterload-reducing effect. Nesiritide, a synthetic b
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