Decompensated heart failure is associated with high rates of morbidity and mortality and it is responsible for numerous hospitalizations. The current approach to acute exacerbations is based on diuretics, vasodilators and inotropes. Compared with the impressive development of new therapeutic agents designed for other cardiovascular diseases, little progress has been observed in developing new drugs for the treatment of decompensated heart failure. Moreover, a series of controlled clinical trials failed to show a better outcome or a reduction in morbidity during treatment with inotropes, even though promising results were recently observed in controlled clinical trials with new classes of drugs, such as calcium sensitizers and nesiritide; these agents will probably modify the treatment options of decompensated heart failure in the coming years.