The patients with heart failure (HF) often exhibit some degree of muscle wasting restricted to the lower limbs. This loss of tissue may become more extensive in some patients, usually when their HF is more advanced, and may affect all body compartments. The underlying metabolic causes are very complex and differ from patient to patient. Three essential contributors are dietary deficiency and loss of nutrients through the digestive tract and metabolic dysfunction. The development of cachexia is an ominous sign and new drugs will be added into our therapeutic armamentarium to fight against cardiac cachexia in the near-future.