Heart failure has emerged as one of the most pressing health care issues in the United States. It is estimated that 4.8 million people have chronic heart failure, and approximately 400,000 new cases are diagnosed each year. Since the incidence of heart failure increases significantly with age, its prevalence is likely to increase as the population grows older. The American Heart Association and American College of Cardiology developed clinical practice heart failure guidelines to assist physicians in the diagnosis and management of patients with heart failure, in the hopes of reducing hospitalizations and mortality. These guidelines emphasize the importance of echocardiography in the management of acute and chronic heart failure. However, the guidelines do not elaborate on all the potential applications of echocardiography for this condition. This review was undertaken to examine in detail, the role of echocardiography in the initial management and long-term follow-up of patients with heart failure.