Heart failure (HF) is a syndrome with high prevalence, morbidity and morbility and its incidence and health care burden are growing. Acute heart failure (AHF) can be defined as a rapid change in signs and symptoms in patients with chronic heart failure (CHF) or new-onset (de novo) HF that requiring urgent therapy. Clinical diagnosis and treatment must be made concurrently, as AHF is a severe condition and the prognosis depends on the early identification of underlying heart disease. Diagnosis is a challenge for primary care and emergency physicians, and clinical cardiologist, due to the fact that the symptoms are often nonspecifics, and sometimes common with other highly prevalent diseases. In most cases the use of additional tests, especially early performing an echocardiogram, enables the clinical differential diagnosis. The appropriate treatment is as important as identifying potential triggers and comorbidities that have precipitated or can unduly influence the patient's clinical situation.