Heart failure represents almost 5 % of all hospital admissions and both mortality and health care cost on account of those patients are high. The proportion of patients on ICU with heart failure of various origin (mostly as a results either of primary heart damage or as a result of secondary heart damage due to multiple organ failure) has increased rapidly during the last two decades. Heart failure occurs mostly as a result of ischaemic heart disease and the prevalence of heart failure increases in those with both ischaemic heart disease and hypertension. Increased sympathetic activity, renin-angiotensin–aldosterone axis, vasopressin, endothelin and atrial natriuretic peptides play the most important role in developing heart failure. Current definitions, diagnosis and recommended treatment of heart failure are based on recommendation issued by European Society of Cardiology. Echocardiography together with assessment of atrial natriuretic peptide plasma levels are preferred methods for diagnosis. The current therapeutic approach to heart failure is stratified according to levels of evidence based medicine methodology. The control of underlying cause and optimizing of myocardial oxygen delivery to failing heart without increasing oxygen consumption at the same time represent the cornerstone of therapy in heart failure patients. Diuretics, vasodilators together with inotropic agents (dobutamine, phosphodiesterase inhibitors and recently calcium sensitizers, if necessary), are the mostrecommended drugs in this setting.ACE inhibitors and beta-blockers are the key agents for long-term pharmacological therapy in chronic heart failure patients. Non-pharmacological modalities are also mentioned.

        Key words: heart failure – pathophysiology – diagnosis – treatment – guidelines