Acute cardiac failure is the principal complication of all forms of heart disease. The goal of therapy is to improve the quality and length of life, and to prevent progression of the syndrome. Although improvement in survival with medical therapy has been obtained at each stage of heart failure, quality of life has been more difficult to assess and regression of the disease is most apparent before severe symptomatic heart failure develops. Decisive recent progresses have been the development of cardiac transplantation and of assisted circulation techniques, and the generalisation of reperfusion therapies at the acute stage of myocardial infarction.