Background: Heart failure (HF) is a global health problem. Like most chronic diseases, HF also courses with acute exacerbations, which have been found to be associated with significant morbidity and mortality. A substantial proportion of acute decompensated heart failure (ADHF) patients clinically present with volume overload. Methods: The goal of this work was to review the current literature and recent guidelines of European Society of Cardiology and American Heart Association/ American College of Cardiology regarding the management strategies in patients with ADHF and volume overload. Results: In the setting of ADHF and volume overload, prompt diagnosis of the disease should be made. Underlying pathologies should be identified and corrected if possible. Specific approaches may be necessary depending on the etiology. Discussion: Current guidelines direct clinicians on the appropriate principles of management in this group of patients; however, approach should be individualized.