Evaluation of cardiac structure and function is vital for diagnosing, managing, and determining prognosis in cardiac diseases. Echocardiography is the predominant first-line imaging modality due to widespread availability, lack of ionizing radiation, and capacity to deliver real-time anatomical and functional data. However, echocardiography has limitations like acoustic window issues and the inability to characterize tissue fully. Cardiac MRI (CMR) is an essential complementary modality, allowing accurate quantification of ventricular parameters and superb soft tissue characterization. Techniques like late gadolinium enhancement and mapping discern diffuse myocardial pathology. Stress CMR can uncover ischemia with high accuracy. CMR is beneficial when echocardiography is suboptimal or in complex congenital cases. SPECT myocardial perfusion imaging excellently detects flow-limiting coronary artery disease, aiding diagnosis and risk stratification. Positron emission tomography characterizes myocardial metabolism, distinguishing viability. Hybrid imaging identifies active inflammation in cardiac sarcoidosis, directing immunosuppression. Cardiac CT angiography effectively rules out or confirms coronary artery disease non-invasively. Emerging CT applications include perfusion imaging and ischemia detection. However, CT confers radiation exposure. An integrated multi-modality approach leveraging complementary capabilities optimally evaluates complex cardiac patients with comorbid myocardial, valvular, vascular, and pericardial abnormalities. The choice of initial test and adjuncts depends on the clinical query, expertise, and technical availability. Further technological advances will continue to refine diagnostic precision and enhance patient care incrementally.