Acute heart failure has relatively recently been recognized as a distinct entity within the continuum of heart failure. Patients with acute heart failure present to the emergency department when they are unable to breathe, and their pathophysiology differs from that of patients sitting in a doctor's office. Medical literature is just beginning to catch up with this distinct and challenging problem. This issue of Heart Failure Clinics should make an important contribution to the literature with its coverage of transportation and EMT services, triage, and specific treatment for patients in acute heart failure, including advanced treatment methods.