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A 42 year-old man with hypertension, hyperlipidaemia and tobacco abuse presented with typical chest pain. The pain was located in the substernal area, described as squeezing, non-radiating and awoke him from sleep. The pain was not associated with shortness of breath, abdominal pain, nausea and diaphoresis. On physical examination, blood pressure was 171/115 mm Hg, heart rate was 60 beats/min, heart sounds were normal without murmur, lung fields were clear and there was no peripheral oedema. Initial ECG showed upsloping ST segments in leads V2–V4. Given the presence of multiple cardiac risk factors, the description of pain and the findings of the ECG, coronary angiography was pursued (Figure 1A–D).
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