Chronic heart failure (CHF), congestive usually, is often the end stage of many heart diseases. Despite the undoubted progress in the treatment, CHF continues having high mortality rates and with frequent hospital admissions and re-admissions. Knowledge of patient's natural history is very important in order to address the disease and to prevent or delay the development of the syndrome in its fullest expression. The onset of CHF starts before symptoms, due to the presence of risk factors. The diagnosis is based on the symptoms and physical signs. Notwithstanding the measurement of plasma natriuretic peptide concentrations is the diagnostic key in patients with a suspected diagnosis of CHF, it is always necessary the echocardiography to identify structural or functional cardiac disorders.