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I bought this graphics card as i had upgraded the rest of my system and my 8600GT was a little lack luster. Boy what a difference this thing made! I wont go into system specs but i have a fairly good pc and i get around 250 fps on full graphics in counter strike source with EVERYTHING going on, ie smokes, grenades, multiple gunshots etc.
When your system starts up this card is incredibly loud, but dont fear beacuse once teh drivers load the fan speed slows right down to less than that of a 'silent' Nexus 120mm fan. The card itself is not humungous, but is still reasonably large. Not a problem if you have a full atx case, worth checking sizes if your on micro-atx.
Between this and my geforce 8600 and my previous ATI 9800 ive found no visual difference on desktop and web browsing, i feel this card does provide a slightly clearer picture when playing FPS's though.
Ive had this card for about 2 months now and so far no reliability issues, ive never even heard the fan spin up to an audiable RPM whilst playing games. It was also very easy to install, much like any other graphics card.