BACKGROUND Nuclear myocardial perfusion imaging (MPI) involves the use of radiotracers to generate scintigraphic images of the myocardium. It is the best validated and most standardised of all cardiac imaging modalities, demonstrating regional perfusion ventricular wall motion and accurately calculating reproducible left ventricular ejection fraction. Physiological or pharmacological stress can be used to uncover myocardial ischaemia. OBJECTIVE This article provides an update on the use of MPI for the triaging of chest pain, monitoring of known ischaemic heart disease, and cardiac event prediction in the general practice setting. CONCLUSIONS A normal stress MPI study is an unambiguous outcome. A perfusion defect on a stress MPI study may be produced by stress ischaemia, stable infarction, hibernating myocardium, or by a variable mixture of all three. Patient access to nuclear MPI is good with most nuclear medicine departments offering nuclear cardiology services. Nuclear cardiology is safe and reliable, and deserves to be a part of the routine diagnostic armamentarium in general practice.