Acute heart failure is not a single clinical presentation. From progressive congestion to acute pulmonary oedema, isolated right ventricular failure, and cardiogenic shock, recognizing the underlying phenotype is essential to guide early management. 🔎 Key clinical takeaways: 🫀 Identify the phenotype early — treatment intensity depends on the clinical presentation. 🩺 Integrate clinical assessment, ECG, natriuretic peptides, troponin, and bedside imaging. 🫁 Recognize respiratory failure early and provide appropriate ventilatory support. 💧 Do not simply prescribe diuretics. Monitor urine output, natriuretic response, renal function, and electrolytes. ⚠️ Identify the precipitating cause, particularly acute coronary syndrome, arrhythmias, infection, and pulmonary embolism. 📊 Risk stratification and appropriate disposition are essential components of emergency care. The clinical goal is clear: the right treatment, for the right phenotype, at the right time. 📚 Reference: Miró O, et al. Acute heart failure in emergency settings. European Heart Journal. 2026. Clinical consensus statement. #AcuteHeartFailure #HeartFailure #Cardiology #EmergencyMedicine #PointOfCareUltrasound - @dr.alejandro_cathlab