Acute decompensated heart failure (ADHF) is common in the elderly, who often have various heart diseases and co-morbidities. Another term, acute heart failure syndrome (AHFS) means that it is an association of heart conditions and that it must be treated immediately. An overview of ADHF treatment begins with common hyperacute-phase treatments including advanced cardiac life support, alleviation of dyspnea, and alleviation of congestion and/or hypo-perfusion. Non-invasive positive-pressure ventilation (NPPV) is often effective for dyspnea. Congestion and hypo-perfusion are assessed with Nohria-Stevenson classification, and should be properly adjusted. Then, the patients are treated differently, dependent on the clinical scenario, which helps to discriminate cardiac failure and vascular failure. After echocardiography, specific treatment for specific heart disease is performed.