Mitral regurgitation after myocardial infarction is the result of multifactorial processes involving local and global left ventricular remodeling. The prevalence of mitral regurgitation varies from 11% to 59%. Published studies differ greatly in design, inclusion criteria, duration of follow-up, and technique of mitral regurgitation assessment. However, they consistently indicate that mitral regurgitation after myocardial infarction carries an adverse prognosis with increased risk of death and heart failure independently of previously known indicators of risk after myocardial infarction. Mitral regurgitation is often clinically silent; therefore, it should be systematically evaluated by echocardiography. Standard color Doppler imaging is a highly sensitive method to detect even mild degrees of ischemic mitral regurgitation. One unique advantage of echocardiography is that it accurately quantifies the severity of mitral regurgitation by measuring the effective regurgitant orifice area and the regurgitant volume using Doppler methodology. Therefore, the evaluation should include precise quantification of the degree of mitral regurgitation to best appraise the ensuing risk. Current medical options rely chiefly on angiotensin converting enzyme-inhibitors and beta-blocker therapy, and surgical approaches offer future promise. Both categories of therapeutic approaches should be evaluated by randomized controlled trials.