Coronary artery disease (CAD) is one of the leading causes of mortality in the world. Treadmill test is a very useful non-invasive test to diagnose and stratify the risk of CAD. Lead aVR is usually a neglected lead while reading the ECG. We describe a case demonstrating the importance of subtle changes in lead aVR that has got a direct angiographic correlation with left main CAD. Therefore picking up the subtle clues on ECG may help in stratifying the risk and optimal treatment of the patient in a timely fashion.