This book sets echocardiography within a routine clinical context. It aims to synthesise guidelines into a pragmatic clinical approach to real patients providing a step-by-step guide to performing, reporting, and interpreting a study. We wrote it imagining we were the calm voice of a senior echocardiographer teaching a junior colleague. This edition has been extensively revised with an expansion of sections on acute, intensive care, and emergency medicine. COVID-19 has necessitated limiting exposure of both patient and operator to infection and caused a huge increase in waiting lists. This has sharpened the debate over matching the level of scan to the clinical question and also highlights the importance of collaboration between clinicians and echocardiographers