Cross sectional descriptive study was conducted on cases of acute congestive heart failure (ACHF) admitted to Abu El Reesh Hospital Cairo University during a period of 6 months, Congenital cardiac abnormalities were the most common (79.5%) followed by cardiomyopathies (11%) and rheumatic heart disease (9.25%), Females represented 55.6% of cases, Doses of anti-failure medications were significantly higher in cases of cardiomyopathy than the other 2 groups, Giza government had the highest percentage of cases (24%), March had the highest incidence of admitted cases of AHF (20%).