Echocardiography is increasingly recommended for the diagnosis and assessment of patients with severe cardiac disease, including acute heart failure (AHF). Echocardiography and LUS can assist in the rapid assessment of patients with acute dyspnoea and hypotension, and have the potential to transform the way in which clinicians assess and manage critically ill patients with AHF and cardiogenic shock. The current AHF guidelines are cautious in recommendations for the widespread use of advanced echocardiography techniques in the acute care setting because robust applicability data are lacking, interpretation of findings requires highly specialized, in-depth knowledge of cardiac pathophysiology, and there is potential for harm by injudicious application in this patient population. The opportunities to improve diagnostic accuracy, reduce delays in treatment, and improve outcomes through the use of advanced echocardiography need to be further explored.

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