There are several basic requirements for a useful and reliable ultrasound examination. Proper implementation of 2D and M-mode echocardiography is among the most important. These methods represent the beginning of each heart ultrasound examination and their reproducibility is the major quality indicator of every single ultrasound examination. If properly implemented, these methods bring reliable and reproducible data on the size of cardiac chambers, wall thickness, but also on global and regional myocardial kinetics. The 2D and M-mode are the keys of heart disease classification in many different clinical settings and represent the basics of a prospective follow-up in many pathological conditions. These methods are nowadays used not only to diagnose, but also to guide the treatment and to assess therapeutic effects of different interventional, operative or conservative procedures. We should not forget that the results of 2D and M-mode evaluation may represent the decision point on the most appropriate time for operative treatment in valvular heart disease. Adequate knowledge of 2D and M-mode echocardiography is a reliable basis for routine echocardiography, as well as they represent the start point for the development of advanced ultrasound skills in this inspiring medical field.