A 59 year-old man was admitted to outpatient cardiology clinics with typical chest pain on exertion(NYHA Class-II) continuing for 1month. Anginal discomfort defined by the patient was not extremely severe. He had no history of medical disease. Also, He did not have other coronary risk factors. His physical examination was completely normal. The ECG at rest showed sinus bradycardia and no significant ST-T change(Figure 1). The trans-thoracic echocardiography revealed no regional wall motion abnormality with normal LV systolic function (EF=58%). He underwent treadmill exercise test on Bruce protocol in order to induce coronary ischemia. At maximal exercise he experienced severe, crushing chest pain on the retrosternal region associated with marked ST elevation in V1-5(Figure 2). The test was emergently stopped and then he was undertaken into the emergency room. Following intravenous nitroglycerine treatment for 10 min, chest pain and ST elevation were resolved. Troponin I and CK-MB levels were found to be normal not only ar admission but also during follow-up. Since then, he underwent coronary angiography.

1. A right coronary angiogram showed no stenosis. ( Movie 1)
2. A left coronary angiogram showed minimal lesion in proximal LAD. ( Movie 2, Movie 3)

We finished coronary angiogram. 2days later, we performed ergonovine stress echocardiography, and the ergonovine provocation test showed wall motional abnormality of LAD territory.( Movie 4)

Then, he was discharged with the medical treatment including calcium channel blocker (a daily dose of 60 mg nifedipine), and 80 mg/day isosorbide dinitrate.