Ischemic mitral regurgitation (IMR) is mitral valve incompetence caused by coronary heart disease. It is mainly pathology of left ventricular wall and subvalvular apparatus. In patients after myocardial infarction IMR adversely affects survival and development of chronic heart failure. Identification and quantification of IMR by quantitative Doppler echocardiography plays the crucial role in stratification and further management. Successful treatment depends on identification and solving of concrete mechanisms leading to development of IMR. It is one of the most challenging issues in current cardiology.