A 46 year old woman presented with sudden onset severe, tight, central chest pain. She had stopped smoking 10 years previously, but there were no other cardiac risk factors. The ECG showed sinus rhythm with marked ST elevation over the anterior chest leads, and she received intravenous tPA within two hours of symptom onset. Despite thrombolysis, diamorphine, and intravenous β blockade, the pain persisted. The ECG showed increased …