 2 Dimensional echocardiography 2D-echo is a conventional standard-of-care tool for non-invasive hemodynamic assessments in adults. In stable settings, heart failure is often characterized and classified according to ejection fraction measured by echocardiography which may be considered a pragmatic gold standard. However, the use of 2D-echo requires highly trained personnel. Obtaining measurements and calculating fundamental cardiovascular parameters such as cardiac output COmay take anywhere between 30 to 45 minutes, which is impractical for any setting, let alone an acute care setting. Further, such personnel are frequently not available in emergency departments. The feasibility of real time haemodynamic assessments is therefore limited with 2D-echo. More sophisticated echocardiographic techniques have been developed in an attempt to overcome the problems of sensitivity to preload and particularly afterload, but have achieved little penetration in critical care. 