Background: Rheumatic heart disease is the commonest cause of cardiac disease in general and Congestive Heart Failure in most sub-Saharan African countries, followed by hypertensive heart disease which is rising along with other non-communicable diseases. However the pattern of congestive heart failure in our setting is not known (1). Therefore the objectives of this study were to assess the common causes of heart failure, common precipitating factors, ED stay of patients admitted with CHF, ED mortality of Patients admitted With CHF and predictors of ED mortality and common clinical presentations of patients with CHF. METHODS: A prospective cross-sectional study was conducted on 128 patients who were admitted to adult emergency medicine department of Tikur Anbbesa specialized hospital, Addis Ababa university, Addis Ababa, Ethiopia with diagnosis of CHF. The study population was 128 patients who were admitted with the diagnosis of CHF, during four Months period, Dec 1/2013 to March 31/2014. The patients condition on discharge or admission to ward was followed. The data were collected using structured pretested data collection tools and analyzed using SPSS for windows version 20.0. Results: During the data collection time frame 128 patients, 75 (58.6%) female and 53 (41.4%) male, with CHF were admitted to the emergency department. Fifty percent of patients were within the age range of 12 to 29 years. CRVHD was the most common ECHO finding in 67 (52.3%) of the patients followed by DCMP 14(10.9%), Corpulmonale 10 (7.8%), IHD 8 (6.3%), HHD 4 (3.1%) and peripartal cardiomyopathy 2 (1.6%). The most common precipitating factor identified was pneumonia 46 (35.9%) followed by arrhythmias 29 (22.7%), discontinuation of CHF therapy 20 (15.6%) and natural course of the disease or refractory CHF in 10 (7.8%) of the patients. Shortness of breath was the commonest symptom 121(94.5%) of patients and tachypnea was the commonest sign 104 (81.3%). Only 38 (29.7%) of patients were disposed from the ED within the first 24 hours. Four patients (3.1%) died at ED and statistically significant predictors of mortality could not be identified. Conclusion and recommendations: The most common cause of CHF at TASH, Ethiopia is CRVHD, which accounts for more than fifty percent of the causes. The most common precipitating factor is pneumonia. Concerned body should focus on prevention, diagnosis and treatment of CRV