Heart failure (HF) is a complex, multisystemic disease defined by structural and/or functional cardiac abnormalities that impair the heart’s ability to meet metabolic demands. It affects over 64 million individuals globally and poses a growing socioeconomic burden due to high morbidity, mortality, and healthcare costs. HF is categorized into three phenotypes based on left ventricular ejection fraction: HFrEF, HFmrEF, and HFpEF, each with distinct pathophysiological mechanisms. Diagnosis relies on clinical signs, echocardiography, and biomarkers such as BNP. The pathogenesis involves neurohormonal dysregulation, mitochondrial dysfunction, and metabolic reprogramming. Besides established treatment regimes, recent advances in therapy include SGLT2 inhibitors and GLP-1 receptor agonists, which offer cardiovascular and metabolic benefits. Moreover, emerging imaging techniques such as cardiovascular magnetic resonance (CMR) enhance phenotyping and enable individualized treatment strategies.