Symptoms which suggest heart failure tend to be either sensitive (for example, dyspnoea) or specific (PND, orthopnoea), but no symptom is both. Physical signs which suggest heart failure tend to be specific (raised jugular venous pressure, gallop rhythm), but none of them are sensitive. Echocardiography is essential to diagnose heart failure in suspected cases. Open access echo services seem popular. The ECG can be used as a prescreen to select patients for echocardiography, but some cases of LV systolic dysfunction (2-27% in different reports) are missed by this approach. Measurement of natriuretic peptides (BNP and N-BNP) might become an alternative way to prescreen suspected patients for echocardiography, but more work is required to establish feasibility and accuracy.