Testa-Fernández et al. Journal of Medical Case Reports 2011, 5:304 http://www.jmedicalcasereports.com/content/5/1/304 Page 5 of 6 Figure 4 Electrocardiographic record of “giant R wave” electrocardiogram pattern (lead III) during recovery phase and its normalization after nitroglycerin administration. the patient’s prior symptoms due to cardiac rhythm and blood pressure abnormalities. Rapid administration of nitroglycerin is crucial because it can prevent life-threatening events. Conclusions In this case report, we describe a dramatic, rare ischemic response during ETT that was probably caused by superimposition of a coronary spasm in a severe ste- nosis of a mid-dominant circumflex coronary artery. Consent Written informed consent was obtained from the patient for publication of this case report and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Figure 5 Coronary angiography showing stenoses in mid- dominant circumflex coronary artery. Figure 6 Coronary angiography performed after percutaneous revascularization.