Suspected Lv dysfunction Suspected Heart Failure because of signs because of symptoms and signs Assess presence of cardiac disease by ECG, X-ray or Normal Heart Failure or lv dysfunction Natriuretic peptides where available) unlikely Tests abnorma Imaging by Echocardiography Normal (Nuclear angiography or Heart Failure or LV dysfunction MRI where available) unlikely Tests abnormal Assess aetiology, degree, precipitating factors and type of cardiac dysfunction Additional diagnostic tests where appropriate Choose therapy (e.g. coronary angiography) Figure 2 Algorithm for the diagnosis of heart failure or left ventricular dysfunction