Heart failure is a common, complex clinical syndrome resulting from the impaired ability of the heart to cope with the metabolic needs of the body, leading to breathlessness, fatigue and fluid retention. It is a progressive disease characterised by high levels of morbidity and mortality. Measuring plasma levels of natriuretic peptides is recommended for ruling out heart failure, as patients with normal levels are unlikely to have heart failure. An echocardiogram is indicated if the natriuretic peptides are elevated, or natriuretic peptide testing is not available.