Myocardial perfusion imaging with stress testing by exercise or pharmacologic methods and functional evaluation of the left ventricle are useful in many patients. Uses include determination of diagnosis and prognosis of patients with coronary artery disease, preoperative evaluation, management and risk stratification following cardiac events, evaluation of therapy and assessment of left ventricular status in many situations, including postmyocardial infarction and chemotherapy with cardiotoxic drugs. Many recent advances in imaging techniques, stress methods and radiopharmaceuticals make this a complex area of clinical diagnosis. It requires a coordinated effort of primary care, cardiology and nuclear medicine specialists to provide optimal patient care.