Abstract: High altitude heart disease (HAHD) refers to the disease of myocardial damage and circulatory system dysfunction caused by a series of pathophysiological changes under long-term low pressure and hypoxia environment in high altitude districts. HAHD seriously threatens the health of native and immigrated people at high altitude because it is difficult to make early diagnosis and has poor clinical prognosis. Cardiac magnetic resonance imaging can sensitively detect early myocardial abnormalities in HAHD patients due to its high tissue resolution, good repeatability and multi-parameter imaging, and is of great significance in providing scientific evidence for early diagnosis and clinical decision-making. Therefore, cardiac magnetic resonance can be used as a sensitive biomarker for efficacy monitoring, medication guidance and clinical prognosis. This article reviewed the clinical characteristics of HAHD, the mechanism of myocardial injuries and its clinical applications with CMR imaging.