Cardiovascular mortality is falling in most industrialised nations. Primarily responsible for this encouraging trend are preventive measures such as risk-factor modification but improved medical and surgical management have helped too. Clinical decision making in the patient with coronary heart disease demands techniques that not only describe coronary anatomy but also provide functional indices for early detection and to monitor the severity and extent of disease. Nuclear medicine methods can characterise non-invasively myocardial function, perfusion, and metabolism. Novel radiopharmaceuticals, improvements in imaging equipment, and extensive validation have contributed to the growing clinical acceptance of these techniques and to their cost-effective integration in the workup of patients with cardiovascular disease.