Thirteen patients with ischemic coronary heart disease purposely hyperventilated for seven minutes in order to induce hypocapnic alkalosis. One patient experienced chest pain, and one exhibited chemical signs of myocardial hypoxia. Heart rate, blood pressure and myocardial O2 consumption did not change significantly. Coronary blood flow decreased and coronary (a-v)O2 difference widened. Since the alkalosis increased the blood O2 affinity, the fall in PO2 in coronary venous blood was proportionately even greater than the fall in O2 concentration. Thus, hypocapnic alkalosis due to hyperventilation interferes with myocardial O2 supply by 1) coronary vasoconstriction and 2) increased O2 affinity of blood.