A 79-year-old male patient was referred to our hospital for a follow-up of his coronary heart disease. He was on medication for hypertension and was asymptotic. The referring physician reported that the patient was diagnosed with multiple significant stenoses (#1 90%, #2 99%, #5 50%, #7 50% and #13 75%) by invasive coronary angiography in 2001, but had refused to undergo invasive revascularization. In 2010, the referring physician convinced the patient to undergo cardiac MR for follow-up. A sub-endocardial myocardial infarction with ischemia in the inferior wall was revealed. The patient again preferred not to be treated by invasive angiography. Although multiple coronary stenoses were known, the main concern was whether the myocardial infarction or ischemia had worsened. This time, cardiac CT was indicated and an integrated cardiac CT examination was performed to assess the coronary arteries as well as the condition of the myocardium.