[Severe congestive heart failure as a medical emergency]

Acute severe heart failure is one of the leading causes of emergency hospitalization in Switzerland. The decompensation often occurs in the setting of preexisting heart failure. A precise diagnosis is of paramount importance because of the bad prognosis of this disease, and because there is a broad therapeutic armamentarium which can significantly modify the disease process. Besides the physical examination, echocardiography is the most helpful additional examination in these patients. The therapeutic strategy is to eliminate causes and precipitating factors, to assure blood and oxygen supply to the organs, to optimize cardiac work, to normalize intravascular and secondarily extravascular volume, to treat arrhythmias and to combat neurohumoral activation. The World Health Organisation and the European Society of Cardiology have published guidelines providing useful algorithms for diagnosis and treatment.