In this unit you have learnt that heart failure is one of the most common conditions seen and results in a high mortality. It can result from failure of the heart muscle as with coronary heart disease, hypertension or cardiomyopathy or as the result of mechanical stresses like valvar regurgitation or stenosis. The heart and circulation have many adaptations to cope with heart failure but in the long term these prove inadequate. There are many grades of heart failure and the two main types are systolic and diastolic heart failure. Echocardiography is of immense value in estimating the ejection fraction, chamber volumes and mechanical problems. There are several lines of treatment including the use of diuretics, angiotensin converting enzyme inhibitors and blockers, inotropic agents like digitalis and the cautious use of beta blockers in special situations. Mechanical and electrical devices are also in use. When all else fails one resorts to cardiac transplantation but the number who can have access to such facilities are very few indeed.