Despite major improvements in the treatment of heart disease, it remains a major source of morbidity and mortality on a global scale. Currently, invasive coronary angiography remains the gold standard for identification of obstructive coronary artery disease. However, recent advances in computerized tomographic (CT) techniques of the heart allow for accurate, noninvasive characterization of atherosclerotic coronary disease and other cardiac abnormalities. The calculation of coronary artery calcium scores with electron beam CT has largely been supplanted by high-resolution CT angiography using multislice detectors (MSCT) which can provide detailed multidimensional visualization of cardiac structures. Although evaluation of obstructive coronary disease is the primary use of MSCT, its use in identifying congenital defects, planning thoracic procedures and characterizing cardiac function continues to grow. Accordingly, appropriate incorporation of MSCT/CT angiography into clinical practice continues to be defined. Several limitations to MSCT remain which reduce its accuracy, such as in patients with arrhythmia and in patients with either coronary stents or heavily calcified coronaries. Despite its current limitations, MSCT remains a rapidly advancing field and an increasingly valuable tool for the noninvasive evaluation of cardiac pathology.