About 90% of the Heart Failure patients are admitted due to congestive symptoms in the emergency departments, this is the leading cause of hospitalization and also a prognostic factor for cardiovascular death. The success of therapy in these patients comes from the proper use of the resources at our disposal. Objective: Provide relevant knowledge to the clinician for the comprehensive approach to patients with heart failure and fluid overload. Methodology: Narrative review. Results: Loop diuretics continue to be the first line of management, reducing mortality rates, but there are also other pharmacological strategies when an adequate response is not achieved, among them we find thiazide diuretics, mineralocorticoid receptor antagonists and in cases of distribution vascular, the use of nitrates and hypertonic saline solution has been described. Conclusions: The gradual and timely management of diuretic drugs decreases the cost and improves the prognosis of patients with heart failure and fluid overload.