Noninvasive ventilation is becoming increasingly important in the treatment of acute and chronic respiratory failure. However, noninvasive ventilation not only influences respiratory failure but also cardiac (dys-)function. Furthermore, cardiac comorbidities are often present in systemic diseases with respiratory failure such as COPD or obesity hypoventilation syndrome. This review covers the (patho-)physiological causes of hypoxic and hypercapnic respiratory insufficiency and its treatment with noninvasive ventilation. A special focus on acute and chronic effects on cardiac function will be addressed.