[The incidence and prevalence of heart failure (HF) is constantly increasing, its mor­bidity and mortality are still high, thus the disease burden is huge and its proper treatment is of paramount importance. Subs­tantial evidence on improving its prognosis remains available only by the treatment of chronic heart failure with reduced left ventricular function (HFrEF). There have been published a number of “milestone” studies in the last decades, the results of which fundamentally determined the HF therapy until recently. Baseline therapy for HFrEF has been placed on three pillars for a long time: angiotensin-converting-en­zyme inhibitors (ACEI), beta-blocker (BB), and mi­ne­ralocorticoid receptor antagonist (MRA) are included in different heart failure guide­lines with I/A level recommendation. The ground-breaking highly important PARADIGM-HF study was published in 2014, and examined an entirely new class of drugs, the sacubitril/valsartan, which belongs to the group of angiotensin receptor blocking/neprilysin inhibitors (ARNI) in HFrEF patients. Results of this study showed that sacubitril/valsartan significantly reduced the primary composite endpoint of CV mortality and HF hospitalization by 20% and reduced overall mortality by 16% compared to an active comparator enalapril, which has the broadest evidence in HFrEF therapy. The 2016 European Society of Cardiology (ESC) HF guidelines recommended the use of sacubitril/valsartan with an I/B evidence level as a replacement for an ACEI to further reducing the risk of HF hospitalization and death of out-patients with HFrEF who remained symptomatic despite optimal treatment with an ACEI, a BB and an MRA. Later, several smaller studies concerned sacubitril/valsartan with slightly different indications and in other patient groups. The PIONEER-HF study demonstrated that early initiation of sacubitril/valsartan therapy after the stabiliza­tion of acute HF is safe and effective in HFrEF patients, reduces more rapidly the NT-proBNP levels - which correlates with HF prognosis -, than the enalapril. The TRANSITION and TITRATION studies provided useful information on the initiation of sacubitril/valsartan therapy and the strategy of dose titration. The appearance of sacubitril/valsartan opened a new era in HFrEF therapy a few years ago, an era we are actually experiencing in Hungary. Thanks to SGLT-2 inhibitors, it is also possible that we are at the door of an even newer therapeutic era. This question is expected to be answered in the new ESC HF-guidelines to be published soon this year. ]

[The heart responds to the damage to the heart muscle with various changes that are regulated by complex processes. If the harm is irreversible, changes that begin as an adaptation can become chronic and permanently worsen heart function. The author details below the pathological remodelling of the left ventricle that can lead to heart failure. It covers the types of heart failure based on the latest recommendations and presents the echocardiographic examination methods that can be used to assess the diastolic, systolic and right ventricular function of the heart.]

[Diuretics (especially thiazide derivatives and indapamide that also has vasodilator efficacy) are considered as first line treatment in hypertension. They are particularly favourable in the treatment of overweight, elderly, isolated systolic hypertensive patients suffering from type 2 diabetes and metabolic syndrome or in mild renal and cardiac insufficiency. They can be ideally combined with other antihypertensive agents (primarily with angiotensin-converting enzyme inhibitors, angiotensin receptor blocking agents és béta-blockers). If hypertension is associated with left ventricular hypertrophy or stroke indapamide is the appropriate choice. In case of left ventricular dysfunction and heart failure thiazide and/or furosemide is the adequate option. Low dose diuretics have no clinically relevant side effects and reduce cardiac mortality to the same extent as other pharmaceutical interventions.]

[Acute heart failure may develop in previously healthy hearts. Nevertheless, structural abnormalities can facilitate its development and also, chronic heart failure can progress into acute stage. Considering the total cost of care in the patient's life, this is the most expensive heart disease. The clinical signs and physical abnormalities are usually of diagnostic power, however, instrumental investigations are necessary to recognize complications and to guide therapy. Patients should be monitored in well equipped coronary care units. Therapy consists of medications, coronary revascularization and use of mechanical assist devices.]

[Heart failure has a poor prognosis despite the advances in pharmacological treatment. The utilization of non-pharmacological treatment with appropriate indications significantly improves the quality of life and life expectancy of these patients. Cardiac resynchronization therapy with biventricular pacemaker has a clinically proven efficacy in the treatment of heart failure associated with intraventricular dyssynchrony. Implantable cardioverter- defibrillators decrease the mortality from sudden cardiac death. Heart transplantation is needed in cases refractory to therapy. There are several other non-pharmacological treatment approaches, including mechanical circulatory assist devices, total artificial heart and ultrafiltration, whose routine application is not recommended due to limited clinical experience, but the initial results are promising.]