The majority of patients who present with acute decompensated heart failure require the addition of vasodilators to adequately reduce filling pressures and improve symptoms. Conventional therapies such as nitroglycerin and nitroprusside, although relatively effective, are difficult to use. Nesiritide, a natriuretic peptide and neurohormonal antagonist with potent vasodilator properties, may be a reasonable alternative. It offers several benefits in safety and convenience over conventional vasodilators, making it particularly suitable for both emergency department and inpatient use.