The assessment of patients with a suspected cardiac failure aims to an early and precise diagnosis and risk stratification. Only natriuretic peptides have demonstrated to be clinically useful. Brain natriuretic peptide stands out due to its diagnostic and prognostic value. However its results should be cautiously interpreted in the clinical context, bearing in mind possible confounders. The combination of markers can provide a better risk stratification and compensates the limitations of individual markers. Each new marker gives a new insight on the underlying physiopathology of cardiac failure and proposes new therapeutic approaches.