A 38 year-old female had suffered from effort angina for 2 years. Myocardial perfusion imaging showed reversible redistribution and transient ventricular dilation, indicating high probability of coronary artery disease. Coronary catheterization revealed patent coronary arteries. Combining clinical history, electrocardiogram, echocardiography and coronary catheterization results, she was discharged with hypertrophic cardiomyopathy as final diagnosis. In conclusion, abnormalities in myocardial perfusion imaging are sensitive for myocardial ischemia in hypertrophic cardiomyopathy but not equal to coronary artery disease.