Does an echo rule out heart failure?

Yes: The 2d echocardiogram will give you an excellent assessment of the structural and functional status of the heart. Evaluate valvular function, ventricular function and pulmonary pressures. A possible exception may be the case of end stage renal failure and volume overload.

Close: An echocardiogram paired with a careful history and physical examination can establish a diagnosis of heart failure with a high degree of certainty in the hands of competent practitioners. Diastolic cardiac dysfunction can be overlooked. Bad imaging or sloppy interpretation can challenge accuracy. If findings are subtle and mild, the diagnosis may take more diligence to establish.