Heart failure represents the leading cause of death, especially among the elderly. Despite the development of numerous therapeutic strategies, heart failure prevalence is still increasing. Ergo, exploring the molecular mechanisms underlying aging-related heart failure seems to be of particular relevance. Intriguingly, the fi elds of cardiovascular disease and aging, which have remained largely separate hitherto, seem to have a common point in the sympathetic nervous system. Indeed, mounting evidence indicates that adrenergic receptors are functionally involved in numerous processes underlying both aging and cardiovascular disease. This chapter will review the pathophysiological role of the sympathetic nervous system in heart failure and cardiac aging.