Objective: To compare the diagnostic value of coronary angiography and cardiac ultrasound in segmental ventricular wall motion abnormalities of coronary heart disease. Methods: 60 cases of coronary artery disease patients admitted to Balihan Town Central Health Hospital of Ningcheng County, Chifeng City, Inner Mongolia, from February 2021 to February 2024 were treated as the research subjects, and they were divided into the control group (n = 30) and the observation group (n = 30) according to the sequence of the admission time of the patients, and the control group performed conventional coronary artery angiography, and the observation group performed cardiac ultrasound for diagnosis, and the diagnostic accuracy and incidence of adverse reactions in the patients of the two groups were compared. The diagnostic accuracy and the incidence of adverse reactions were compared between the two groups. Results: The results of the study showed that the correct diagnostic rate of coronary angiography was 30/30 (100.00%), and the diagnostic accuracy of cardiac ultrasound was 29/30 (96.67%), and there was no statistically significant difference in the diagnostic accuracy of the patients in the two groups (P < 0.05). In the comparison of the adverse reactions, the control group had 3 cases of nausea, 1 case of dizziness, and 1 case of vomiting, a total of 5 cases, and the incidence was 16.67%, while the observation group did not have any adverse reaction, and the incidence was 16.67%. 16.67%, the observation group did not have any adverse reactions, and the two groups of patients were statistically significant in the comparison of data (P < 0.05). Conclusion: Compared with coronary angiography diagnosis, the diagnostic accuracy of cardiac ultrasound is slightly lower, but within the acceptable range, and can reduce the incidence of adverse reactions after examination, which is worthy of clinical promotion and application.