This article reviews the role of myocardial per fusion scintigraphy (MPS), a non-invasive cardiac imaging technique, in the diagnosis, assessment and management of coronary heart disease. An injection of a small amount of radioactive tracer and a gamma camera are used to produce images of blood flow to the myocardium after stress (exercise or pharmacological stress) and at rest. This allows reversible per fusion defects to be distinguished from fixed defects. As well as a tool in the diagnosis of coronary heart disease, it may also provide information to guide decisions on interventions, and to risk-stratify patients ahead of surgery.