An independent directional Doppler system operating in pulsed or continuous-wave mode and a real-time spectral analyzer with a 3 ms temporal resolution have been used to supplement conventional real-time and M-mode echocardiography. Examination techniques as well as findings in normal and abnormal hearts are presented. Continuous-wave Doppler is most useful for detection of peak frequency shifts for calculation of valvular gradients while pulsed Doppler is superior in the detection of small jets of abnormal flow and in display of spectral broadening. Real-time spectral analysis allows interactive selection of peak frequency shifts, can separate coincident flows by signal intensity and depicts high frequency valvular movements to rival the capabilities of M-mode.