Background: Myocardial blush is a simple, widely available, and virtually costless technique for the immediate diagnosis of microvascular impairment, and confirms myocardial tissue-level perfusion at time of coronary angiography. Objective: Emphasizing the correlation between left ventricular functions and angiographic evidence of myocardial blush grade (MBG) in patients with ischemic heart disease (IHD). Patients and Methods: The present study included fifty patients who had been admitted to AL-Azhar University Hospital (Damietta) between February 2015 and October 2015 by IHD, and eligible to coronary angiography. Patients in the study were subjected to full history with special emphasis on age, sex, other risk factors for coronary artery disease (CAD), and analysis of anginal pain. Echocardiography to assess LV functions was done immediately before coronary angiography and assessment of MBG. Results: The mean age of studied cases was 56.5 years. Most of our cases were males (68%), and the most frequent risk factor was hypertension (54%). Ejection fraction was within normal limits in 54% of cases. Mild, moderate and severe impairment of LV systolic functions were found to be 24, 10 and 12 % respectively. Most of the patients (47 for right coronary, 43 for left circumflex and 44 for left anterior descending arteries) had thrombolysis in myocardial infarction (TIMI) grade III. Myocardial blush grading was assessed for both right and left coronary arteries. The most frequent finding was grade III for both left (50%) and right (62%) systems, and the least was grade I for left (16%) and right (10%) systems. Impaired MBG of the left coronary system was associated with old age, male sex and low blood pressure, while right coronary system had no such association. Impaired MBG of both right and left coronaries was related to impairment of left ventricular systolic function, but not related to diastolic function. Also, degree of MBG was related to degree of TIMI on both right and left coronaries. In contrast, degree of systolic function by echocardiographic assessment was not related to TIMI of right coronary system or TIMI left circumflex (LCX) artery. Finally, MBG was related to degree of stenosis of all coronary arteries except LCX artery. Conclusion: Myocardial blush grade was correlated with left ventricular systolic function. Impaired myocardial blush grade was related to TIMI and degree of coronary stenosis. Impaired MBG of left system was associated with old age, male sex and low blood pressure.