Chest pain caused by myocardial ischemia or not: sometimes the old handgrip test can solve the dilemma

We describe the case of a patient with typical chest pain but negative maximal bicycle exercise-electrocardiogram test and for whom significant coronary artery disease was hypothesized by a positive handgrip exercise test and demonstrated by coronary angiography. Despite negative exercise stress test, handgrip as well as other provocative tests have to be considered when the pretest probability of coronary artery disease is intermediate and the symptoms are typical for angina.