A prospective study of 315 cases of cardiac failure admitted to the General Hospital at Katsina, in the northern savanna region of Nigeria, is presented and the pattern emerged is compared with that of the southern forest region of the country. Although the diseases causing cardiac failure were similar in these two areas, their incidence and pattern showed wide variations. Cardiomyopathies were the commonest cause (47%) of cardiac failure in the northern savanna, congestive cardiomyopathy being the predominant type (31%). Endomyocardial fibrosis (EMF) commonly encountered in the south, was absent in the north; Peripartum Cardiac Failure (PPCF), rarely reported from the south, formed the commonest cause of cardiac failure among the females in the north. Rheumatic heart diseases (RHD) showed a uniform distribution throughout the country. Anaemia caused a higher percentage (13%) of cardiac failure in the north. Hypertension caused relatively fewer (12%) cardiac failures. The variations in the pattern of cardiac failure in these two areas of Nigeria are probably partly attributable to geographic geo-climatic, socio-economic, ethnic and cultural differences.