Syncope, an angina equivalent?

Syncope is one of the cardinal symptoms of cardiovascular system, but coronary artery disease (CAD) presenting with syncope is rare. We present a case of a young male who had recurrent exertional syncope. During evaluation, he had polymorphic ventricular tachycardia on exercise stress test, followed by ST segment depression in recovery. Coronary angiogram revealed critical stenosis in left anterior descending artery. Post revascularization syncope did not recur. CAD should always be considered as one of the possibility during evaluation of syncope.