Pulmonary edema, defined as the accumulation of fluid within the lung parenchyma, is often a result of acute heart failure. Occurring in the setting of elevated cardiac filling pressures, pulmonary edema can be described as cardiogenic in etiology. It is a life-threatening condition, demonstrating alarming mortality rates. Respiratory failure occurs due to inadequate oxygen delivery to tissues and altered respiratory mechanics, requiring immediate assessment and management. Cardiorespiratory collapse may occur rapidly. Understanding the pathophysiology and clinical presentation of acute cardiogenic pulmonary edema provides a basis for treatment. While measures are taken to diagnose and address the underlying causes of cardiogenic pulmonary edema, offloading the myocardium with diuresis and vasodilatory therapy is the mainstay of treatment. Correction of dyspnea and hypoxemia is essential in the initial stabilization phase. In conjunction with ongoing clinical assessment, providing escalating methods of respiratory support (including non-invasive ventilation) has been shown to be useful in treating this type of respiratory failure.