A 74 year old lady with previous PCI to the LAD artery had diffuse disease in the LCx artery with an occluded OM1 branch on X-ray angiography (arrow, A). Her breast size was average (bra-cup size C) as seen on CMR survey images (arrows, B). Left ventricular mass (65.4g) was within the lowest tertile for our population. Stress perfusion CMR identified subtle inducible ischemia in the inferolateral wall (arrows, C) concordant with the angiogram. However, SPECT did not identify any significant inducible ischemia (D). This case illustrates the difficulties of imaging subjects with small hearts (mostly females) with both perfusion techniques. Although subtle, CMR is still able to identify inducible ischemia as a result of its greater spatial resolution.