Congestive heart failure is a serious pathological heart state which is manifested by cardiorespiratory signs and symptoms. It is present in the chronic state in many elderly people and in those with previously damaged hearts. An understanding of the pathophysiology and etiology of congestive heart failure along with the factors predisposing the elderly to congestive heart failure aids in the initial diagnosis and treatment. Management of the patient with chronic congestive heart failure and prevention of acute congestive heart failure requires very close followup and assessment of the patient for early signs and symptoms of congestive heart failure. Active involvement of the patient in the care plan along with ongoing education and counseling is essential for good management.