Nesiritide, is a recombinant form of human-B-type natriuretic peptide (hBNP) used for the therapy of acute decompensated heart failure. hBNP produces natriuresis, diuresis, hypotension, and smooth muscle relaxation preventing myocardial fibrosis and vascular smooth muscle cell proliferation. Nesiritide treatment of patients with heart failure causes balanced arterial and venous dilatation with reduction in the pulmonary capillary wedge pressure (PCWP) and increases the cardiac index. It is administered intravenously with a recommended dosage as intravenous bolus of 2 microg/kg/min followed by a continuous infusion of 0.01 microg/kg/min for less than 48 hours. Clinical experience has shown that in patients with heart failure, this drug reduces PCWP, increases cardiac index without changes in heart rate, with the subsequent improvement in clinical symptoms of dyspnea after 3 hours of treatment. Also, there is evidence of less ventricular tachyarrhytmia when compared with dobutamine and better tolerance with less secondary effects when compared with nitroglycerin. It has been suggested that there is an increase in the mortality hazard ratio at 30 days with this treatment, however clinical trials using Nesiritide did not analyze mortality at short or long term as primary end-point. Recently published meta-analysis reported that there is no-increase in mortality at 30 days or 6 months with this treatment. Nesiritide is a novel and effective option for the medical treatment of acute decompensated heart failure.