Targeting Acute Congestion With Tolvaptan in Congestive Heart Failure

Inclusion Criteria: * ≥ 18 years of age * Daily oral dose of furosemide between ≥ 40 mg(or equivalent) * Identified within 24 hours of presentation, defined for purposes of this study as the time of initial dose of intravenous loop diuretic * Prior clinical HF diagnosis that was treated with oral loop diuretics for at least 1 month * Admission for acute decompensated Heart Failure (HF) as determined by * dyspnea at rest or with minimal exertion * Brain Natriuretic Peptide (BNP) \> 400 or NTproBNP \> 2000 pg/mL AND at least one of the following additional signs and symptoms: * Orthopnea * Peripheral edema * Elevated JVP (Jugular Venous Pressure) * Pulmonary rales * Congestion on Chest X-ray * No plan for revascularization, cardiac transplant, of ventricular assist device implantation, or other cardiac surgery within 60 days of randomization * Signed informed consent Exclusion Criteria: * Serum Na \> 140 meq/L * Received IV vasoactive treatment or ultra-filtration therapy for HF since initial presentation * Treatment plan during current hospitalization includes IV vasoactive treatment or ultra-filtration for HF * Systolic Blood Pressure (SBP)\<90mmHg * Serum-Cr\>3.5mg/dl or currently undergoing renal replacement therapy . Known underlying liver disease * Hemodynamically significant arrhythmias * ACS(Acute coronary syndrome) within 4 weeks prior to study entry * Active myocarditis * Hypertrophic obstructive, restrictive, constrictive cardiomyopathy * Severe stenotic valvular disease * Complex congenital heart disease * Constrictive pericarditis * Clinical evidence of digoxin toxicity * Need for mechanical hemodynamic support * Terminal illness (other than heart failure) with expected survival time of less than 1 year * History of adverse reaction to Tolvaptan * Enrollment or planned enrollment in another randomized clinical trial during this hospitalization * Pregnant or breast-feeding * Inability to comply with planned study procedures