To the Editor:Exercise?induced ST?segment elevation is an uncommon clinical scenario with a prevalence of 0.15%.[1] ST?segment elevation during exercise is a marker of both transient and severe ischemia. Appropriate treatment is crucial because coronary vasospasm can result in acute coronary syndrome, syncope, life?threatening cardiac arrhythmias, and even out?of?hospital cardiac arrest.[2] Here, we report on a patient with exercise?induced myocardial ischemia and life?threatening cardiac arrhythmias due to coronary vasospasm.