A very physically active 49-year-old male with a history of labile hypertension and hypercholesterolemia with an LDL cholesterol of 126 mg%. He underwent an exercise stress test which revealed reversible inferoseptal ischemia at a peak heart rate of 171 bpm and peak blood pressure of 195/85. In the expert's opinion, the results suggest that the patient has silent myocardial ischemia and may be at risk for sudden cardiac death, especially in light of the marked exertional level of activity.

49-year-old-male complained of a feeling of oppression behind the sternum, always when there was emotional stress. His coronary CT showed Severe high level stenosis with wall irregularities of the right coronary artery. The treatment options are coronary revascularization procedure versus optimized pharmacologic management.