 This project will provide essential data on the potential for clinicians without access to echocardiography but with access to USCOM, to effectively and safely assess patients with cHF, and adHF. Confirming the value of USCOM will enable the earlier diagnosis of heart failure and cardiogenic shock, earlier appropriate management, will remove the guesswork and uncertainty as whether or not to administer diuretics, intravenous fluid, vasodilators, vasoconstrictors, inotropes, chronotropes or blockers. This will open the door for trials orientated to optimizing haemodynamics in the cold and acute critical care settings, thus permitting optimal use of life-saving therapies, and optimizing survival. Such early treatment options should reduce the need for admission to hospital and length of hospital stay. 