The present review outlines the clinical potential of magnetic resonance (MR) spectroscopy of the heart. The main acquisition and postprocessing techniques of myocardial phosphorous (31P) and proton (1H) MR spectroscopy are illustrated, along with the possibilities these techniques offer for assessing the myocardial metabolism of phosphates and the presence of lipids. Particular attention is paid to the significance of the main peaks of the myocardial spectrum of 31P: phosphomonoesters (PME), inorganic phosphate (Pi), phosphodiesters (PDE), phosphocreatine (PCr), and gamma-, alpha- and beta-adenosine triphosphate (ATP). The main findings of clinical research are presented with regard to myocardial hypertrophy and hypertrophic and dilated cardiomyopathy, ischaemic cardiomyopathy and myocardial involvement in multisystem disease such as muscular dystrophy and diabetes mellitus. Lastly, the recent prospects offered by technological innovations that increase the signal-to-noise ratio and reduce acquisition times are assessed with reference to the radiologist dedicated to cardiac imaging.