The incidence of congestive heart failure in the US population is increasing as more women and men survive with chronic hypertensive and atherosclerotic heart disease. Almost half the patients in the US with heart failure are women. Hypertension, diabetes mellitus, and cigarette smoking are all more potent risk factors for the development of heart failure in women than in men. Important differences in presentation and mortality explain gender differences in the clinical course of heart failure. Overall mortality is lower for women than for men with symptomatic heart failure. Some but not all of this difference can be explained by a lower rate of ischemic heart disease. Standard treatments for congestive heart failure, including angiotensin converting enzyme inhibitors and beta-blockers, have been shown to be equally efficacious in men and in women. Preliminary data on angiotensin II receptor blockers suggests equivalent benefit with further trial data awaited. Peripartum cardiomyopathy is a form of heart failure unique to women, occurring in the last stages of pregnancy or within 5 months after delivery. Approximately half of affected women regain normal ventricular function but for those who do not, the risk of recurrent symptomatic heart failure and mortality during subsequent pregnancies is high.