Chronic heart failure (CHF) is a major cause of morbidity and mortality in industrialized countries. As societies are aging, efforts are directed toward early interventions to preserve quality of life as well as lower mortality. However, because of the paucity of specific symptoms, an early diagnosis and management of CHF might be challenging. In contrast, biochemical markers, which can be measured easily and without inter-observer variability, are now being carefully examined. Since CHF is a complex syndrome, a single biochemical marker cannot reflect its multiple manifestations. An ideal biochemical marker should 1) be a prognostic indicator, 2) reflect the therapeutic response, 3) be heart specific 4) be independent from other markers 5) reflect the pathophysiology of CHF, 6) assist in the early diagnosis of CHF, and 7) be reliable throughout the various phases of the syndrome, from before the onset of its clinical manifestations through its end-stage. This review summarizes our current understanding of biochemical markers of CHF based on its pathophysiology.