Postdischarge mortality and morbidity from acute heart failure syndrome (AHFS) are high, affecting nearly half of all discharged patients within 90 days. Emergency department therapy remains largely empiric, with minimal evidence to support definitive recommendations to guide therapy. However, lessons learned from recent registries and trials suggest an approach to initial management based on clinical profiles, as defined by high, normal, or low blood pressure. Clinicians are provided with a practical and consensus-driven approach to everyday AHFS management.