Cardiovascular disease (CVD) is the number one cause of death globally, and morbidity and mortality are highest in low- and middle-income countries (LMICs) due to unavailability and unaffordability of medical resources for diagnosis and management of CVD. This has led to disastrous economic consequences on the individual, household, and societal levels in these regions. Cardiovascular imaging is essential to the care of patients with CVD; however, access to cardiovascular imaging is very limited in low- and middle-income countries due to the expense of equipment and challenges in training healthcare personnel to correctly order, acquire, and interpret studies. The state-of-the-art tools for cardiac imaging include echocardiography (echo), coronary angiography and left ventriculography, nuclear imaging, cardiac computed tomography, and cardiac magnetic resonance imaging. Of the available cardiac imaging modalities, echo is the most widely used in LMICs because it is safe, portable, relatively inexpensive, and can diagnose a variety of CVDs. Additionally, inexperienced practitioners can be trained in a relatively short period to perform a focused cardiovascular exam using echo, such as for screening rheumatic heart disease. Handheld or pocket-sized echo machines are particularly useful, and the images can be interpreted locally or uploaded for remote interpretation by expert cardiologists. Instituting the infrastructure for cardiovascular imaging alone is not sufficient. Clinicians in LMICs must be trained to properly refer patients and interpret the results. Additionally, patients must have access to and be able to afford necessary medicines and surgeries for the treatment of CVDs. The gap in CVD treatment in LMICs may be further reduced through the use of telemedicine and mobile cardiovascular imaging tools, along with continued international efforts to lower infrastructure costs and train local providers in their use.