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A 49-year-old with chest pain and bioprosthetic aortic valve
  1. Krithika Loganath1,
  2. James Shambrook2,
  3. Alastair James Moss3
  1. 1 Department of Cardiology, University Hospital Southampton, Southampton, UK
  2. 2 Department of Radiology, University Hospital Southampton, Southampton, UK
  3. 3 Department of Cardiology, University Hospital Southampton, Southampton, UK
  1. Correspondence to Dr Krithika Loganath, University Hospital Southampton, Southampton SO16 6YD, UK; krithika.loganath{at}

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Clinical introduction

A 49-year-old man presented to the emergency department with sudden-onset left-sided precordial chest discomfort after cycling home from work. He usually cycled up to 60 miles per week and did not report any history of antecedent anginal symptoms. Fourteen years previously, he underwent a bioprosthetic aortic valve replacement (29 mm Carpentier-Edwards, Edwards LifeSciences) with re-implantation of the left coronary artery. Of note, he had recently reported transient loss of vision that was attributed to ocular migraines. On clinical examination, he appeared systemically well and ECG demonstrated sinus rhythm with no S-T changes suggestive of ischaemia. Serum blood analysis revealed an elevated high-sensitivity troponin I, 865 ng/L …

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