Case presentation:

• Male.
• 67 y.o.
• Atypical angina (abdominal discomfort at stress).
• Normal exercise ECG.
• Submitted for stress myocardial perfusion study (MPS).
• Exercise/rest MPS was performed with 99mTc-sestamibi.

Teaching points:

• Abdominal pain / discomfort is not infrequent in patients with inferior wall ischemia.
• Sensitivity of exercise ECG is limited, especially in patients with one-vessel disease.
• Functional non-invasive stress imaging is indicated in patients with intermediate probability of CAD.
• MPS has the ability to identify disease in individual arteries, since the perfusion abnormalities usually correlate closely with coronary territories.