Acute decompensated heart failure (ADHF) is a leading cause of hospital admission and many factors are known to precipitate decompensation. We aimed to assess the decompensating factors of heart failure and the management of patients admitted to the emergency department (ED). A total of 107 patients were examined, all diagnosed with ADHF in the ED of the Baghdad Teaching Hospital, from June 2017 to December 2017, and presenting with decompensation (pulmonary oedema, peripheral oedema, and fatigue). The mean patient age was 62.5 ± 9.8 years (range: 43–85 years); the majority of them were in their 7th decade (37.4%), and men were slightly more than women. Hypertension was the most commonly associated comorbidity (68.2%), followed by diabetes mellitus (57.9%), coronary artery disease (51.4%), dyslipidaemia (37.4%), arrhythmia (28%), and chronic obstructive pulmonary disease / asthma (23.4%). The most common presentation was pulmonary oedema (88.8%) followed by peripheral oedema (61.7%), and fatigue (26.2%). Uncontrolled hypertension was the most common precipitating condition for decompensation (58.9%), followed by infection (39.3%), acute coronary syndrome (31.8%), arrhythmia (27.1%), non-compliance (11.2%), and anaemia (2.8%). The majority of the admitted patients were managed with intravenously-administered (i.v.) diuretics (92.5%) that may have been combined with oxygen therapy (63.6%), antibiotics (58.9%), β-blockers (50.5%), nitroglycerin (40.2%), i.v. fluids (38.3%), and/or digoxin (19.6%).