Ischemic heart disease (IHD) - one of the major human diseases, which account for a significant portion of all cardiovascular deaths of the world. In spite of recent decrease in cardiovascular mortality, IHD remains the leading cause of death in the developed world. The application of surgical and percutaneous myocardial revascularization promised to be a safe and effective method to control symptoms and to improve prognosis in this disease. However, clinical results do not match these expectations: most revascularized patients remain symptomatic, a large fraction continues to require antianginal medications, and about 10% suffer of either death or myocardial infarction within 2.5 years. In the meanwhile, the clinical variety of IHD is rapidly changing, with a growing prevailing of elderly patients, diabetics, and heart failure patients. Pharmacologic intervention of cardiac energy metabolism, by enhancing the synthesis of nitric oxide (NO) via administration of L-arginine, appears as an innovative and attractive addition to treatment of IHD patients.