It is to evaluate the diagnostic ability of the serum cardiac markers in myocardial ischemia by analyzing high sensitive troponin I, N-terminal pro-brain natriuretic peptide, Creatine Kinase, Creatine kinase-MB, Myoglobin, ischemia modified albumin and heart type fatty acid binding protein. Total no of 56 cases and 33 healthy individuals were enrolled in the study and the preliminary blood samples were collected. The subsequent blood samples were collected from the 38 ischemic patients at one hour who had shown positive TMT for ischemia, where other patients does not meet criteria of ischemia. A comparative study for the markers was done between control and cases, pre and post TMT of ischemic cases; finally area under the receiver operator curve was constructed to see the diagnostic efficiency for the markers. NTproBNP, IMA, hscTnI and CK-MB significantly raised in ischemia. NTproBNP (92.98 +/- 18.76 and 112.52 +/- 21.36) and hscTnI (1.80 +/- 0.61 and 2.12 +/- 0.60), shown significant elevation in post exercise (p<0.0001) compared to pre exercise. Receiver operating curve analysis indicates NTproBNP (AUC, 0.830), hscTnI (AUC 0.86), CK-MB (AUC 0.81), and IMA (AUC, 0.79), better diagnostic efficacy. Marked increase of serum hscTnI, NTproBNP, CK-MB and IMA with more AUC, can be considered as effective diagnostic makers in ischemia.