Echocardiography of coronary arteries is challenging, however current high–end systems offer sufficient quality for several clinically relevant applications of the method. Transesophageal echocardiography allows the imaging of proximal coronary arteries with high quality and power to detect stenotic flow. Transthoracic imaging of coronary ostia is feasible to define anomalous coronary arteries and other congenital abnormalities. This approach is also used for recording of distal coronary flow at rest and during vasodilator administration to calculate coronary flow reserve. Transthoracic detection of coronary stenosis is strongly dependent on acoustic window but is very specific based on the finding of localized high-velocity diastolic flow.