Nowadays, with the progress of medicine, chronic heart failure is no longer an incurable disease that can be feared, but can be prevented, controlled, and completely cured through various measures and medical treatments. Here I briefly discuss the clinical manifestations, diagnosis and treatment of heart failure in the context of my own treatment of two cases of heart failure. Heart failure is a pathological syndrome due to the development of various heart diseases, which finally leads to the enlargement of the heart, weakness of the heart contraction, and the inability to properly undertake the delivery of blood to meet the needs of the body, also known as cardiac insufficiency. The former is caused by myocardial ischemia due to narrowing of the coronary arteries supplying blood to the heart, while the latter is caused by lesions of the heart muscle itself. The clinical manifestations of cardiac insufficiency are mainly chest tightness and dyspnea of varying degrees, which first appear after heavy activity, and can appear after light activity when the disease develops, and when the disease worsens to the final serious stage, chest tightness and shortness of breath can appear even without activity, when the patient cannot lie down and lie flat, and needs to sit in order to breathe. In addition to this, the patient may have decreased exercise tolerance, which may be manifested as shortness of breath and weakness during exertion or daily activities, limited activity, as well as fatigue, fear of heat, dizziness, panic, and poor diet. Physical signs include swelling of both lower extremities, finger pressure on the lower extremities, sunken edematous skin, abdominal edema in the liver area, abdominal distension, and dilatation of the skin surface veins in the neck due to obstruction of blood flow, and in some patients, lung rales due to pulmonary stasis can be heard when breathing. Cardiac examination may also reveal signs such as heart murmur, gallop rhythm, tachycardia, and arrhythmia. Diagnosis The diagnosis of cardiac insufficiency requires the following auxiliary tests in addition to the above clinical manifestations, which can clearly diagnose not only the presence or absence of heart failure and its etiology, but also the severity of heart failure. X-ray examination: heart enlargement in the chest film is manifested as enlarged heart shadow, cardiothoracic ratio ≥ 50%, pulmonary stasis is mainly manifested as enhanced vascular shadow in the pulmonary hilar, increased vascular shadow in the upper lung, the presence of interstitial pulmonary edema can make the lung field blurred. ECG: Various arrhythmias, premature heartbeat, conduction block, tachycardia, etc. Echocardiogram 1. There may be different degrees of enlargement of the heart chambers and changes in the structure and function of the heart valves, and the enlargement of the heart chambers is directly proportional to the severity of the disease. 2. Estimation of cardiac function: ventricular systolic function index: left ventricular ejection fraction (EF)$€˂50%, the smaller the EF value the worse the function, the lower the survival rate and the worse the prognosis. The increase of BNP level can reflect the increase of left ventricular end-diastolic pressure, which is significant for the diagnosis of heart failure, regardless of the heart failure caused by systolic insufficiency and diastolic hypoplasia. It also has a good predictive value for the prognosis of heart failure. Patients with persistently elevated BNP levels and increased incidence of cardiac events and cardiac mortality have a poor prognosis, and those with reduced BNP after treatment have an improved prognosis. Treatment A large number of clinical studies in recent years have shown that short-term treatment to correct the hemodynamic abnormalities in heart failure and relieve symptoms does not improve the long-term prognosis of patients and reduce mortality. Therefore, the treatment of heart failure cannot be limited to symptom relief, but must take a long-term view and adopt comprehensive therapeutic measures, including etiological treatment, regulation of the compensatory mechanisms of heart failure, and reduction of its negative effects such as neuroendocrine activation and ventricular remodeling. I. Drug therapy Diuretics are the most commonly used drugs in the treatment of heart failure to reduce edema and relieve bruising symptoms through sodium and water drainage, such as dihydrocoumaric acid and tachyphylaxis. Diuretics are taken orally, usually twice a day, once in the morning and once in the afternoon, preferably before four o’clock in the afternoon. The diuretic dosage can be increased or decreased according to the amount of urine, and the small amount of urine can be continuously increased until the swelling of both lower limbs subsides, and then the dosage is reduced or stopped. (b) Drugs to increase heart contraction Digoxin, half a capsule per day orally, can be used for a long time and has a good effect on improving the symptoms of heart failure, but Digoxin can slow down the heart rate, if there is a significant slowdown of the heart rate then a pacemaker can be placed and such drugs can be used again under the protection of the pacemaker. (C) to improve the long-term prognosis of the heart 1, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers application: this is a class of anti-hypertensive drugs, regardless of whether the patient has elevated blood need to be applied in large doses throughout life, the representative drugs are Lottinghin, Dynavin, etc. 2, the application of anti-aldosterone agents: spironolactone, i.e., anthropoietin, one capsule per day for oral administration. 3, the application of beta-blockers: beta-blockers can improve the efficacy of drugs that increase cardiac contraction; reduce myocardial oxygen consumption, anti-ventricular arrhythmia, and reduce the rate of sudden death. This is one of the most important drugs to treat chronic heart failure and improve the prognosis of patients, representative drugs: metoprolol, carvedilol and bisoprolol. Note that generally when the heart failure symptom condition is stable, start with small doses and gradually increase the dose for long-term maintenance. However, it also has the side effect of slowing down the heart rate. If there is a significant slowing down of the heart rate in the application, a pacemaker can be placed and these drugs can be used again under the protection of the pacemaker. If the patient’s symptoms do not improve with the use of drugs and the patient has the following conditions: ECG shows complete left bundle branch block and cardiac ultrasound shows cardiac function EF ≤ 40%, a biventricular resynchronized pacemaker can be placed, which can significantly relieve the symptoms of heart failure and improve the patient’s prognosis.