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Three-dimensional echocardiography (3DE) with real-time volumetric imaging can be a vital modality in clinical practice. Despite its potential, it remains underutilized in the acute care setting. We present two cases describing the use of 3DE in the emergency department (ED) for acute heart failure (AHF) and discuss the potential benefits of routine use in acute care settings. Three-dimensional echocardiography offers unique information as it relates to cardiac structure and function, and can be valuable for diagnosis and clinical decisio