Case presentation: - Male. -38 y.o. - Exertiona chest pain -No CAD risk factors -Study: Exercise/ Tetrofosmin. - 75kg weight. - Ht 180 cm. Teaching points: -This is an intermediate probability pre-test case (young male with no risk factors and chest pain). -Myocardial perfusion imaging (MPI) is indicated since whatever the result is, it will have impact on patient management (Bayes’ theorem). - Sensitivity of MPI is much higher than exercise ECG for ischemia detection. -This result is high-risk for cardiac events, so the patient should be considered for urgent invasive management (angiography + PTCA).