Eighty-six patients presenting with lower extremity pain on exertion underwent treadmill peripheral arterial stress testing with simultaneous cardiac monitoring. Of these patients 19 went on to have vascular reconstruction. Cardiac monitoring of peripheral arterial stress testing is a sensitive method of revealing occult cardiac disease in these high risk patients. It provides valuable information that can contribute to the surgical management of these patients. Specifically, ischemic exercise EKG patterns developed in 69.2% of patients with non-ischemic resting EKG patterns. Further, 80% of patients denying cardiopulmonary symptoms during peripheral arterial stress testing developed ischemic exercise EKG patterns. Of nine patients with significant ischemia on treadmill testing, two had vascular reconstruction postponed until after coronary artery bypass, four had extra-anatomic bypass. Two cardiac-related complications occurred, both in patients with ischemic exercise EKG patterns undergoing femoral-popliteal bypass.