Magnetic resonance spectroscopy provides information about metabolic processes in living tissues. The resulting information may be more sensitive and specific than that obtained using techniques that rely on functional or structural measurements. Although the preponderance of applications to date have been in physiologic investigations in animals, clinical applications are emerging. Reports in the past two years have appeared evaluating the clinical use of phosphorus spectroscopy to detect ischemic heart disease, cardiomyopathy, and cardiac transplant rejection. Active research using nuclei other than phosphorus for spectroscopy will expand the potential clinical applications. Technical developments, including improved surface coil design, wider use of high-field magnets and new pulse sequences, will allow improved sensitivity and spatial localization in the future.