about 75 y old patient with typical chest-pain with irradiation of left shoulder, dyspnoea; high-risk-patient (diabetes mellitus type 2, arterial hypertension, hyperlipoproteinaemia). In ECG I found no specific signs for myocardial ischaemia; in TTE no myocardial movement disorder. Using strain-rate-analysis we found a posterior/inf. and small anteroseptal movement disorder. high-sensitive Troponin was positive. In cardiac catheter we found a two vessel-desease (RCA, LAD) with leading high-grade stenosis of RCA.