The feasibility of studying myocardial perfusion with myocardial contrast echocardiography using intraaortic or intracoronary injections of contrast medium has been established both in animal models and humans. However, the assessment of myocardial perfusion using venous injection is dependent on the availability of contrast agents that can opacify the left ventricular myocardium following a venous injection. Such agents are currently being evaluated in animal models. Using data from left atrial injections of contrast, this review briefly highlights the principles that govern the study of myocardial perfusion from venous injections of contrast. The value of such an approach in the setting of chronic coronary artery disease and acute myocardial infarction is discussed.