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The diagnosis of heart failure is essentially based upon the presence of typical symptoms and signs of congestion or a low cardiac output as well as the objective evidence of cardiac dysfunction. Basic tests include clinical examination, ECG, and chest x-ray. However, findings from these tests are neither absolutely specific nor sensitive for a diagnosis of heart failure. A low B-type natriuretic peptide concentration in a patient with acute dyspnoea makes the diagnosis of heart failure as the cause of a patient's symptoms unlikely. If HF is not unlikely based on ECG, x-ray, and BNP, an echocardiogram is recommended. Echocardiography is the single most useful tests to detect cardiac dysfunction and to identify the exact mechanism underlying the patient's symptoms of heart failure, which is essential to establish an appropriate treatment plan.