Clinical assessment combined with objective investigations such as echocardiography, chest radiography, ECG, and renal chemistry are essential for the accurate diagnosis of suspected heart failure.
Clinical assessment is mandatory before detailed investigations are conducted in patients with suspected heart failure, although specific clinical features are often absent and the condition can be diagnosed accurately only in conjunction with more objective investigation, particularly echocardiography. Although open access echocardiography is now increasingly available, appropriate pre-referral investigations include chest radiography, 12 lead electrocardiography, and renal chemistry.
M K Davies (2000) studied this question.