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A 65 year old man with type 2 diabetes mellitus presented with ischaemic chest pain. The admission ECG revealed ST elevation in V2–V3 (see online supplementary material image) and the patient promptly underwent an invasive coronary angiogram with a view to primary percutaneous intervention. The angiogram revealed no flow-limiting lesions in the left coronary system and moderate, mid vessel, non-flow limiting disease of a dominant right coronary artery (RCA) which did not warrant intervention (figure 1A, B, see online supplementary video). Transthoracic echocardiography was performed the following day but was of poor diagnostic quality and did not demonstrate any significant …
Contributors All authors have read and approved the case. Each author has contributed significantly to the work. AM was responsible for the review of literature and writing the case, GM was responsible for interpretation of images and contributed to writing the case. DS was the consultant in charge of the patient's care.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.