Heart failure (HF) is a prominent fatal cardiovascular disorder afflicting 3.4% of the adult population despite the advancement of treatment options. Therefore, a better understanding of the pathogenesis of HF is essential for exploring novel therapeutic strategies. Hypertrophy and fibrosis are significant characteristics of pathological cardiac remodeling, contributing to HF. The mechanisms involved in the development of cardiac remodeling and consequent HF are multifactorial, and in this review, the key underlying mechanisms are discussed. These have been divided into the following categories thusly: (i) mitochondrial dysfunction, including defective dynamics, energy production, and oxidative stress
(ii) cardiac lipotoxicity
(iii) maladaptive endoplasmic reticulum (ER) stress
(iv) impaired autophagy
(v) cardiac inflammatory responses
(vi) programmed cell death, including apoptosis, pyroptosis, and ferroptosis
(vii) endothelial dysfunction
and (viii) defective cardiac contractility. Preclinical data suggest that there is merit in targeting the identified pathways
however, their clinical implications and outcomes regarding treating HF need further investigation in the future. Herein, we introduce the molecular mechanisms pivotal in the onset and progression of HF, as well as compounds targeting the related mechanisms and their therapeutic potential in preventing or rescuing HF. This, therefore, offers an avenue for the design and discovery of novel therapies for the treatment of HF.