Paradigms are a part of our human nature. In the world of medicine and science, they allow investigators to work within a particular, previously accepted framework that provides certain constraints. This is the crux of Newton's quote, "If I've seen so far it's because I stood upon the shoulders of giants." However, in the same way that it allows us to build, it can constrain our thought processes if we fail to accept new data that are ill suited to an accepted paradigm. The physiological mechanisms to explain the phenomenon of chronic congestive heart failure are similar to other paradigms of science, in that they have undergone several shifts throughout their history, and continue to change with new evidence. Here, we seek to explore how our understanding of congestive heart failure has changed.