While extensive research has focused on improving the efficiency and performance of heat exchangers (HXs), identifying the underlying causes of performance degradation remains equally important. Flow and temperature non-uniformities are among the most critical factors affecting performance, often reducing thermo-hydraulic efficiency by approximately 5–10%. These non-uniformities commonly manifest as thermal inconsistencies, airflow maldistribution, and uneven refrigerant distribution. Researchers have observed a notable performance degradation—up to 27%—due to flow maldistribution. Therefore, a clear understanding of their causes and effects is essential for developing effective mitigation strategies to enhance system performance. Despite the notable progress in this area, few studies have systematically classified the dominant non-uniformities associated with specific HX types. This article presents a two-decade review of the causes, impacts, and mitigation approaches related to non-uniformities across different HX configurations. The primary objective is to identify the most critical form of non-uniformity affecting performance in each category. This review specifically examines plate heat exchangers (PHXs), finned and tube heat exchangers (FTHXs), microchannel heat exchangers (MCHXs), and printed circuit heat exchangers (PCHXs). It also discusses mathematical models designed to account for non-uniformities in HXs. This article concludes by identifying key research gaps and outlining future directions to support the development of more reliable and energy-efficient HXs.