Background Coronary artery ectasia (CAE) is characterized by an abnormal dilatation of the coronary arteries, which is a variant of coronary artery disease (CAD). Increased sympathetic activity or decreased vagal modulation of cardiac function assessed by heart rate variability (HRV) analysis has been associated with an increased risk of coronary artery disease and mortality and angiographic progression of coronary atherosclerosis, as well as arrhythmia and sudden cardiac death. Heart rate recovery index is a strong indicator of risk in asymptomatic and symptomatic CAD. To the best of our knowledge, no study has been conducted to investigate the relationship between HRV, heart rate recovery, and CAE. The purpose of this study was to examine the changes in heart rate recovery and HRV measurements in coronary artery ectasia.