The ability of the heart to function as an efficient pump is critically dependent on an adequate blood supply to the myocardium. When myocardial blood supply is reduced (ischaemia), contractile function of the heart is impaired and its cellular electrophysiological properties are profoundly altered. Prolonged ischaemia may result in cell necrosis which, if irreversible, leads to cell death (infarction) and predisposes the heart to ventricular arrhythmias, which in turn may be fatal. In man, myocardial ischaemia is the consequence of narrowing or occlusion of a coronary artery and is usually a manifestation of coronary artery disease which is often associated with thrombosis.