Heart failure is a multi-faceted syndrome with diverse etiologies. Knowledge of the cause can be crucial to therapy. The prevalence and etiology of heart failure has been previously incompletely described in the Indian population and hence this study.Our study was conducted in a total of 500 patients over a period of 10 months in a tertiary care institute. Detailed clinical history, followed by examination and laboratory tests were performed to identify the etiology.310 (62%) were males and 190 (38%) were females. The occurrence of Congestive Heart Failure (CHF) was highest between 50 and 70 years in both males and females. The relation of CHF to various etiologies has been discussed. The Indian data has also been compared with select international studies and the variations discussed.Major etiology of CHF was a combination of CAD, Hypertension and Diabetes Mellitus, accounting for 23.4%. CAD was the single commonest etiology for heart failure.