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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 …
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