Cardiovascular magnetic resonance first-pass perfusion imaging has developed considerably over the past decade. Several studies have shown that this technique is accurate for the detection of myocardial ischemia. In this article we outline the procedure of myocardial perfusion imaging with cardiovascular magnetic resonance as it is performed at our centers, describe the sequences that are currently used in more detail, review our process of image interpretation, and highlight potential pitfalls that we have encountered in our experience with performing this technique in over 2000 patients.