The hemodynamic profile of heart failure (HF) patients may be critical to their clinical outcome, whereby congestion emerges as a particularly important aspect to define therapeutic goals, optimize HF treatment, and determine prognosis. Accordingly, individualized HF management must include several strategies to detect congestion, which might easily be underestimated in chronic HF patients. Therefore, it is important to recognize the true reliability of traditional HF signs and symptoms. The contemporary understanding of HF has brought new value to some aspects of physical examination. Natriuretic peptides have emerged as potential new tools in the diagnosis of congestion in patients with HF, and echocardiography has gained renewed importance in HF management when it is used to investigate hemodynamic profile. The aim of this article is to review and integrate these 3 ways of assessing and monitoring HF patients: clinical findings, natriuretic peptides, and echocardiography.