Dipyridamole cardiac imaging is a useful alternative to exercise stress testing in the evaluation of patients with ischemic heart disease. Intravenous dipyridamole has been approved recently for clinical use. Oral dipyridamole is widely available. The hemodynamic effects of dipyridamole include an increase in coronary blood flow in excess of the increase in myocardial oxygen consumption and cardiac output. The quality of the thallium images is better or similar to that of exercise thallium images. The optimal dose of intravenous dipyridamole is 0.56 mg/kg and the optimal oral dose is 300-375 mg, although higher doses may be necessary in some patients. The sensitivity and specificity of dipyridamole-thallium imaging, whether intravenous or oral, have been shown in a number of studies to be quite adequate and comparable to that achieved during exercise thallium imaging. Dipyridamole-thallium imaging has also been useful in identifying high-risk patients undergoing major elective vascular surgery. The relative merits of dipyridamole imaging versus exercise testing after acute myocardial infarction require further studies.