Congestive heart failure, a constellation of signs and symptoms that result from the heart's inability to provide sufficient oxygenated blood to metabolizing tissues, is a major cause for concern in the elderly. The prognosis is ominous, with a 10% per year mortality rate after the initial CHF episode, and a 30 to 60% per year rate for patients who remain symptomatic despite digitalis and diuretic treatment. Common etiologies in CHF are discussed, and a case history illustrating CHF symptomatology is provided. The role of diuretics, digitalis, ACE-inhibitors, and other pharmacologic agents is reviewed and updated, and the value of patient education is discussed.