Painless myocardial ischaemia and ventricular fibrillation during treadmill stress test

Painless myocardial ischaemia is a frequent occurrence, but its clinical importance has not been realised. We report a case who developed ventricular tachycardia and fibrillation following painless ischaemia during treadmill stress test. Significant left main severe triple vessel coronary artery disease and normal left ventricular functions were found. Symptoms improved following coronary bypass surgery. Thus, painless ischaemia is a potentially lethal phenomenon, and needs careful assessment and treatment.