Heart failure (HF) is a syndrome caused by several types of cardiac dysfunction and most commonly due to left ventricular dysfunction. Chronic heart failure (CHF) prevalence is high 1–2 % of the population and increases to approximately 15 % in the elderly. We reported a clinical case of a 67 year old man with known non ischemic hypokinetic dilated cardiomyopathy who came to the emergency room for worsened dyspnea and orthopnea. The patient had already received a CRT-D implant and after several investigations he has been judged suitable for LVAD implant as destination therapy and added to cardiac trasplant waiting list.