Introduction: The Brody effect is a relatively rare feature of myocardial ischemia, being defi ned by a transient increase in R wave amplitude during the ischemic episode. If extensive, myocardial ischemia reduces contractility and increases left ventricular end-diastolic volume, forcing the ventricle to adopt a nearly spherical shape, for a fairly constant left ventricular surface area. There is the new vertical orientation of natural cardiac electric field vectors, any vector becomeing perpendicular to the spherically shaped surface of the heart, pointing now directly to the closest electrocardiographic electrode and thereby increasing the amplitude of the R-wave (at least in the precordial leads). Methods: We present the case of a female patient, aged 65, admitted for angina at rest, with normal baseline electrocardiogram. The only electrocardiographic sign during the pain was an increase by 3-15 mm of the R wave amplitude in leads V2 – V6, along with small negative U waves in the same territory. Outside pain, ultrasound imaging of the left ventricle was completely normal, as well as serial necrosis markers. Results: Coronary angiography showed 95% stenosis of the middle right coronary artery. Percutaneous transluminal angioplasty with stenting was performed and the patient became entirely asymptomatic. Conclusions: The Brody effect may be the only electrocardiographic sign of coronary artery disease, even in the absence of well-known changes of the ST segment.