The role of thrombolytic therapy in decreasing mortality and improving left ventricular function has been well established. The role of secondary PTCA is still being defined. Current data support a strategy of performing coronary angiography and elective PTCA only in patients with evidence of ischemia after thrombolytic therapy. Despite the trend away from routine early invasive therapy for acute myocardial infarction, accurate definition of coronary anatomy and assessment of left ventricular function will continue to be vital in the management of these patients and provide a continuing challenge for the cardiac radiographer.