The purpose of this study was to determine through noninvasive arm ergometry and radionuclide tomographic imaging the presence of latent coronary heart disease (CHD) in subjects with paraplegia. Assessment of CHD in spinal cord injury, using these methods, has not been addressed previously. Twenty asymptomatic subjects with paraplegia performed arm ergometry exercise stress testing with thallium-201 single photon emission computerized tomography (SPECT) or planar myocardial imaging studies. All subjects had normal resting electrocardiograms (ECG). Only five subjects had ECG evidence of ischemia on exercise testing, whereas 13 subjects, including the five subjects with ECG positive stress tests, had scintigraphic evidence of ischemia. Thus, eight subjects would have been undiagnosed for CHD without thallium-201 SPECT imaging. These individuals had multiple risk factors for CHD and, except for age, were without a statistically significant difference between the groups with positive or negative thallium stress imaging studies. Arm ergometry stress thallium imaging shows a high prevalence of ischemia in subjects with paraplegia.