I have a 46 yo male with no known cardiac risks factors other than stating he may have had hypertension in the past but unsure. No meds. Having chest pain and shortness of breath. EKG in ER was normal, chest xray normal, cardiac enzymes neg. Referred to us for a nuclear stress test and the patient was put on atenolol, ranexa, and imdur. However, non compliant with the imdur because of headaches. A 2 day protocol was used. The patient walked 11 minutes and reached 13.4 mets. 95% to his target heart rate. The patient was short of breath and had chest pain. The Ekg did not really show anything significant. The nuclear images were negative other than the RV showed up prominently on the stress study. An echo showed neg but had 3 small leaky valves. Why would the RV only show up on the Stress imaging. No lung uptake was seen. NO TID levels increased and no Lung heart ratio increase. My concern are we overlooking something. I have some ideas of the cause but I am not for sure if these are correct.