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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 …
Contributors KL contributed to planning and reporting of the work and is overall responsible for the content. JS contributed to the planning of the work. AJM contributed to the reporting of the work.All three authors finalised the article prior to submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.
Patient consent for publication Not required.