The clinical picture of congestive heart failure is reviewed aiming to establish an accurate clinical diagnosis. The EKG and chest X-ray are very useful in the assessment of patients suffering from congestive heart failure. The echocardiogram is a compulsory diagnostic tool to assess the structural disease and evaluate systolic function. Natriuretic peptides are of diagnostic and prognostic help. It is stressed on the need of an optimal medical treatment in these patients.