Echocardiography, in the hands of a skilled user, has proven to be a highly resourceful and efficient diagnostic tool. It provides real-time, localized, accurate information. Echocardiography can also be used to aid various bedside procedures, complementing them with added accuracy and proficiency. Today, more than 60 years after its initial conception, echocardiography is established enough to be in a widespread use even outside the cardiology unit. As echocardiography expands into more diverse scenarios, hospitals have begun to develop and adopt protocols that call for the regular use of echocardiography in their emergency departments. High yield emergency situations where echocardiography has shown great benefit include acute patient complaints due to chest pain, shortness of breath, or circulatory shock. Emergency echocardiography can also provide valuable data about a variety of conditions with cardiac involvement. While echocardiography has shown great promise, results vary due to a number of factors. To promote the proficient use of echocardiography, numerous organizations have provided recommendations for its safe and efficient use in emergency settings. Echocardiography is often regarded as one of the most challenging ultrasound skills for emergency physicians to become comfortable with. Echocardiography, skillfully performed, is an invaluable method for the evaluation of acute cardiovascular presentations in the emergency department.