An approach to heart failure using ultrasound has radically changed the diagnosis, treatment and prognosis of this group of patients. Point-of-care ultrasound (POCUS) helps to accurately identify the diagnosis of heart failure and quantify pulmonary and systemic congestion in this scenario. Point-of-care ultrasound can also be used to identify gross valvular disease, cardiac contractility abnormalities and differential diagnoses. It is an ideal tool in settings without immediate availability of echocardiography, with a positive impact on patients' prognosis. It helps monitor the resolution of congestion and determine the best time to safely discharge patients. Today's clinician should not only be familiar with but also trained in the comprehensive management of heart failure using ultrasound as an extension of the physical exam.