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Although echocardiography is the most widely used cardiac imaging modality in the world, it is often limited by poor endocardial border definition. The development of contrast agents that opacify the cardiac chambers after intravenous injection now makes it possible to acquire high-quality images, even in technically difficult cases. Several studies have now shown that contrast echocardiography improves assessment of global and regional wall motion, enhances observer agreement, and salvages technically difficult studies. In addition, contrast echocardiography is valuable in specific settings, such as the intensive care unit or emergency department, where high-quality images are often most difficult to acquire. Finally, obstacles to the penetration of contrast echocardiography into routine clinical practice (such as cost/reimbursement, logistics, and education) are discussed.