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A 56-year-old man with exercise-induced chest pains
  1. A Vamvakidou1,
  2. S Gurunathan1,
  3. R Senior1,2,3
  1. 1Department of Cardiovascular Medicine, The Northwick Park Hospital, Harrow, UK
  2. 2Department of Cardiology, The Royal Brompton Hospital, London, UK
  3. 3The Biomedical Research Unit, National Heart & Lung Institute, Imperial College London, London, UK
  1. Correspondence to Professor R Senior, Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; roxysenior{at}cardiac-research.org

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Clinical introduction

A 56-year-old man presented to our chest pain clinic with chest pain predominantly on exercise, but also at rest. He actually declared chest pain 1 h before presentation, precipitated by walking to the hospital, lasting for 2–3 min. He had a strong family history of ischaemic heart disease. His ECG was normal. The probability of significant coronary artery disease was intermediate, and he was referred for stress echocardiography (SE) on the same morning. The SE was not performed (only rest pictures acquired), and he was admitted to hospital (see figure 1 and online supplementary video S1 and S2).

Figure 1

(1A and …

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