Imaging of the heart is a central part of the contemporary management of all cardiac conditions and echocardiography is the most important modality. Echocardiography began in its simplest form back in the 1950's with the work of Inge Edler who is regarded as the "Father of Echocardiography". His work started with the simplest form of ultrasound imaging with the development of M-mode scanning. The evolution of more complex modes of scanning continued through the next 40 years with doppler, transoesophageal and the concept of stressing indications. That pace of improvement in quality and clinical application continues into our current period.

Cardiac ultrasound is truly an indispensable part of modern medicine with an ever expanding utility particularly in the acutely ill patient, whether in an emergency room or an intensive care unit. The world of cardiology has enjoyed a revolution in technological procedures in the last 25 years and much of this is allied to the ability to achieve an accurate diagnosis with echocardiography and also the use of real time imaging during such procedures e.g. percutaneous aortic valve replacement and atrial septal defect closure.

Our cardiac surgical colleagues also depend on high quality cardiac imaging not only for planning the most appropriate operation but also to guide the success of their surgical techniques e.g. mitral valve repair, and to detect major complications at the time of surgery to allow immediate correction.

Point of care ultrasound refers to the concept of bringing the ultrasound equipment to the patient wherever that clinical setting might be. Echocardiography machines can now be the size of a mobile phone achieving excellent quality images in a hand held unit. This has led many to believe that the traditional methods of clinical assessment, including auscultation with a stethoscope, may be outdated and romantic ideals. I would challenge this viewpoint and demonstrate that the highest quality of cardiac care comes out of expertise using both techniques, especially in the acute setting.