In the acute phase of heart failure treatment consists of oxygen therapy and (if necessary) CPAP therapy, vasodilatation with nitrates, and furosemide which is given initially as intravenous bolus doses followed by a continuous infusion (if necessary). Morphine is administered according to the symptoms. In the presence of low filling pressures, intravenous rehydration may be needed. A fluid challenge using a small amount of fluid must be carried out before rehydration is commenced. If the patient does not respond to the acute phase treatment other specific therapies may be considered, such as levosimendan. The correction of the underlying cause and aggravating factors is crucial for a favourable outcome. Intensive care treatment and interventional therapies should only be considered if the patient can be thought to have a chance of recovery or the dysfunction of the heart can be considered to be reversible. In severe chronic heart failure, the patient's wishes regarding further medical care (living will) should be explored in good time.