Heart failure is a pathopshyological condition in which the heart as a pump can't meet the metabolic needs of the organism. It is not a separate clinical entity. It is a result of a basic heart condition and of provocing factors. Heart failure is a global problem with rising prevalence due to the aging of the population. Considering the function of the heart and heart cycle in which the failure occurs we can distinguish systolic and diastolic heart failure. In systolic heart failure we have weakened myocardial contraction and in diastolic heart failure we have weakened relaxation of the ventricle. Elevated left ventricle pressure at the end of the diastole is a common finding in both systolic and diastolic heart failure. Symptoms and sings found in systolic heart failure are both present in diastolic heart failure. They differ in the presence of the contraction dysfunction in systolic failure, and in the remodeling of the left ventricle. In systolic heart failure eccentric hypertrophy occurs while in diastolic heart failure we have a concentric hypertrophy. Ejection fraction is reduced in systolic heart failure, while in te diastolic heart failure it is preserved. Systolic heart failure is more represented in the male population and in patients with coronary heart disease. Diastolic heart failure is more common in elderly patients, females, obese patients and those with arterial hypertension and atrial fibrilation. There are special recommendations in the treatment of diastolic heart failure. Similarities and differences between systolic and diastolic heart failure are not completely clarified. It's necessary to conduct more studies to provide a better insight. Knowing this is a foundation of an adequate treatment.