Figure 1 Initial management of a patient with acute heart failure Figure 1 | Initial management of a patient with acute heart failure. Algorithm for the management of patients with acute heart failure (AHF). *Acute mechanical cause refers to myocardial rupture complicating acute coronary syndrome (free wall rupture, ventricular septal defect, or acute mitral regurgitation); chest trauma or cardiac intervention; acute native or prosthetic valve incompetence secondary to endocarditis; aortic dissection; or thrombosis. AHF, acute heart failure; BiPAP, bilevel positive airway pressure; CCU, coronary care unit; CPAP, continuous positive airway pressure; ICU, intensive care unit. Modified from Ponikowski, P. et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. http://dx.doi.org/10.1093/eurheartj/ehw128 (2016), with permission from Oxford University Press and the ESC. Modified from Ponikowski, P. et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. http://dx.doi.org/10.1093/eurheartj/ehw128 (2016), with permission from Oxford University Press and the ESC Jessup, M. et al. (2016) 2016 ESC and ACC/AHA/HFSA heart failure guideline update — what is new and why is it important? Nat. Rev. Cardiol. doi:10.1038/nrcardio.2016.134