Ischaemic heart disease was the leading cause of mortality according to the World Health Organisation in the year 2018 and disease burden keeps increasing steadily across the globe. Early diagnosis and intervention are therefore key in mitigating its effect on society.The exercise treadmill test is an important, cost-effective investigation employed in the evaluation of coronary artery disease, allowing for early diagnosis and a decision on revascularization to be made. Reliable interpretation depends on multiple factors, combined in the Duke Treadmill Score. An early positive test result suggests a severe coronary artery obstruction which requires urgent revascularisation to reduce morbidity and mortality risk. This is a report on a patient who had an early positive test, with subsequent angiographic findings validating the exercise treadmill test results. It also highlights relevant considerations in performing and interpreting the exercise treadmill test.