The syndrome of heart failure is characterized by symptoms that are relatively insensitive and nonspecific. Physical diagnosis may be unreliable even in the hands of experienced clinicians despite the presence of significantly elevated filling pressures or a significantly depressed cardiac output. Over the past decade, the implantable hemodynamic monitor (IHM) has been developed as means of measuring intracardiac pressures over time and understanding the nuances of the hemodynamic derangements of this condition. With improved ability to accurately assess and monitor filling pressures, clinicians can more precisely adjust therapy with the goal of improving patient symptoms and possibly outcomes. Future directions include using the IHM to assist in management of other cardiovascular diseases, such as pulmonary arterial hypertension, and combining this technology with other implanted devices, such as defibrillators.