Echocardiography is a valuable tool in diagnosing acute coronary syndrome in patients presenting with chest pain in the emergency department. After acute myocardial infarction (MI), echocardiography provides substantial information regarding risk stratification, hemodynamic assessment, detection of mechanical complications related to acute MI, and long-term prognosis. It also helps in guiding therapy in patients after MI. However, it provides limited value in less than 10% of patients because of poor image quality. Contrast agent can and should be used to improve the accuracy of echocardiographic assessment.