Modern strains of fast-growing meat type poultry are highly susceptible to heart failure. Heart-related mortalities are observed predominantly in fast-growing broiler chickens, with ascites and sudden death syndrome being the most common heart-related conditions in modern broiler flocks. This paper examines the role of structural, molecular, and biochemical factors pertinent to the pathophysiology of heart failure in fast-growing broilers. Evidence explaining the pathogenesis of acute and chronic heart failure, in the context of the underlying molecular and biochemical changes in the cardiomyocytes, contractile apparatus, and extracellular matrix in the ventricular myocardium are critically evaluated and discussed with reference to the clinical signs associated with deterioration of heart pump function. The secondary pathophysiological effects on the cardiovascular system, resulting from hemodynamic changes associated with the failing heart pump, are also reviewed and critically discussed.