A 58-year-old man with a history of hypertrophic cardiomyopathy (HCM) presented with tightness in the chest and occasional chest pain. The patient had previously been treated with alcohol septal ablation for a left ventricular outflow tract (LVOT) obstruction secondary to HCM. The patient also had several risk factors for coronary artery disease including high BMI (36), hypertension, and diabetes. In view of the clinical possibility of coronary artery disease coexisting with hypertrophic cardiomyopathy, the patient was referred to a stress-rest 82Rb PET/CT myocardial perfusion (MPI) study.