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In patients admitted with respiratory failure, a large proportion is diagnosed incorrectly in the emergency department and an even larger proportion seems to receive inappropriate treatment. Inappropriate initial treatment of these patients in the emergency department is associated with increased mortality. Focused cardiac ultrasound is a simplified echocardiography, performed by a clinician to answer specific, predefined, clinical questions in a given clinical context. The examination has been validated for use in a variety of clinical settings and scenarios including the guidance of prehospital triage, patients with cardiac arrest, patients with undifferentiated shock, patients with cardiopulmonary instability, patients with respiratory symptoms, trauma patients with suspected cardiac injuries, and assessment of the fluid status before fluid loading. When using focused cardiac ultrasound (US) in patients with respiratory symptoms, the typical objectives would be to identify pericardial effusion and enlargement of cardiac cavities, to estimate global systolic left-ventricular function, and to assess the volume status. The routine use of focused cardiac US in patients with respiratory symptoms may help improve the diagnostic accuracy, the proportion of patients receiving appropriate treatment, and possibly the patient outcome. This article gives a practical guide and an overview of some of the current concepts of using focused cardiac US in patients admitted with respiratory symptoms.