Echocardiographic evaluation of patients with right ventricular (RV) ischemia and infarction has a clear clinical relevance, because the presence of RV infarction is associated with a highly increased early in-hospital mortality, which can be dramatically reduced by successful early reperfusion. However, infarcted RV did recover its function regardless of the infarcted artery patency. This observation suggests that RV myocardium almost always remains viable. This article illustrates the clinical value of echocardiography, including the transthoracic and transesophageal approaches, Doppler, and three-dimensional ultrasound, for the assessment of RV dimensions, shape, and global and regional function, and the estimation of right atrial involvement that in cases of ischemia may further modulate RV performance. In addition, the use of stress echocardiography to detect RV ischemia and evaluate the viability of infarcted RV myocardium is discussed.