Much has changed in the field of myocardial ischemia over the past 3 years. The central assumption that coronary artery disease is synonymous in men and women is under revision. Increasingly, the medical community is recognizing the importance of an altered presentation of the myocardial ischemic syndrome in women. Indeed, the very definition of ischemia itself is under revision.There is mounting evidence that ischemia requires a two-stage definition: the first for biochemical evidence and the second for physiological. The method by which one makes the diagnosis of ischemia is also constantly being reviewed. The use of Holter monitoring for ischemic diagnosis is still a topic for debate. Specifically, whether to use two or three leads and where those leads should be placed remains controversial. In fact, there is some question now as to not only the importance of silent ischemia but also whether all angina is ischemia. There is evidence to suggest that some angina is only memory.The traditional epidemiological view of coronary atherosclerotic risk factors is also under review and refinement. An accelerated rate of decline in ventilatory function, lactose tolerance, and serum levels of homocysteine are some of the new epidemiological risk factors that are touted as equal or superior to the traditional ones for predicting long-term mortality and morbidity.And what of the role of inflammation in triggering thrombosis and plaque rupture? Is the incidence of thrombosis the same wherever an atherosclerotic plaque occurs? Is fibrinogen an important risk factor? This review will briefly examine the new findings in each of these areas and discuss the relevant material where appropriate.