Abstract Heart failure is a complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation. The most common cause of heart failure in the UK is coronary artery disease; other aetiologies include hypertension, atrial fibrillation, cardiomyopathies, valvular heart disease, pericardial disease, and intracardiac shunts. Transthoracic echocardiography has a decisive role in the diagnosis, treatment, and follow-up of patients with heart failure. Indeed, its importance was underscored in the UK 2010 National Institute for Health and Care Excellence (NICE) Guidelines for Heart Failure, and in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the diagnosis and management of heart failure. Echocardiography utilizes ultrasound, which has no known adverse biological effects, is non-invasive, and is a relatively low-cost imaging modality. The use of echocardiography in the diagnosis, therapeutic management, and serial follow-up of the increasing number of patients with heart failure has therefore potentially large health benefits with relatively low patient cost.