Noninvasive ventilation (NIV) is now a first-line treatment in emergency, hospital, and intensive care settings, including for patients with cardiac conditions like ischemic and valvular heart disease (VHD). In acute heart failure (AHF), especially when oxygen therapy fails, NIV is recommended to manage hypoxemia and hypercapnia. Acute cardiogenic pulmonary edema (ACPE), often triggered by valve dysfunction, is one of the most common uses for NIV. Early respiratory support, ideally with continuous positive airway pressure (CPAP), helps reduce distress and avoid intubation. NIV benefits both the respiratory and cardiovascular systems. It improves oxygenation, reduces carbon dioxide, and eases breathing by increasing lung capacity and compliance. Cardiovascularly, the rise in intrathoracic pressure reduces venous return and left ventricular (LV) afterload, decreasing pulmonary congestion and improving cardiac output in patients with volume overload. However, in cases with low preload or right ventricular (RV) dysfunction, NIV can worsen hypotension or RV failure, so careful monitoring is essential. Common NIV modes include CPAP, noninvasive pressure support ventilation (NIPSV or BiPAP), and adaptive servo ventilation (ASV). CPAP is widely used for ACPE, while NIPSV provides variable pressure support. ASV adapts to the patient’s breathing pattern, offering more tailored support and reducing risks like apnea and hyperventilation. Although evidence shows NIV can improve cardiac function in valve diseases such as mitral regurgitation, caution is required in conditions like severe aortic stenosis or pulmonary hypertension, where high intrathoracic pressures can be harmful. Therefore, patient selection and pressure settings are crucial for safe and effective use.