Background: Acute heart failure (AHF) is a common and growing medical problem associated with major morbidity and mortality. It is the leading reason for hospital admission among patients over age 65 years. Not much of data is available from India, there are a lot of differences between the western data and available Indian data. Prompt diagnosis, identification of reversible causes and supportive management in ICU is of paramount importance.Methods: This study was conducted at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka after the institutional ethics committee approval. Those patients who were diagnosed to have AHF, were evaluated and treated as per the institution protocols in ICU and standard medical care which includes diuretics, inotropes and vasopressors. All the patients were prospectively studied; investigated for the etiology of AHF.Results: Majority of patients presenting as Acute Heart Failure are of 60 years mean age, with 63% males. Ischemic heart disease is the leading cause of Acute Heart Failure. Shortness of breath was the commonest presentation followed by crackles. Abdominal pain was the most common (28%) non cardiac symptom. There is no significant correlation between the presence of anemia and mortality. Hyponatremia had relation with mortality. 22% had HFpEF, rest had HFrEF. The mean hospital stay was 8.3 days. The study mortality was 9 % and the 30-day mortality was 13 % in our study.Conclusions: Current available data from Indian studies and registries has a lot of difference from the western data with regards to causes, response to treatment, and more such data is needed to frame regional guidelines for better understanding of presentation of heart failure ,treatment and risk factors for mortality.