Diagnostic ultrasound has allowed significant findings to be made in the investigation of cardiac disease in the horse. Because of the limited value of thoracic radiography in the adult horse with cardiac disease, ultrasound is the method of choice to document chamber enlargement, pericardial effusion, valvular abnormalities, and decreased contractility of the myocardium. The apparent changes in the flow characteristics and suspicion of abnormality in the right heart of racehorses need further investigation to fully document the etiopathogenesis of spontaneous contrast.